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Recombinant FSH versus urinary FSH
Abstracts - WARM: In-vitro embryology: new trends in reproductive medicine
Recombinant FSH versus urinary FSH Caserta D, Marci R, Moscarini M Dipartimento di Scienze Ginecologiche, Perinatologia e Puericultura, University of Rome ‘La Sapienza’, Italy Infertility affects approximately 20–25% of couples. Ovarian stimulation is a standard practice. Many drug protocols based on gonadotrophin-releasing hormone agonists or antagonists for pituitary down-regulation and on FSH for ovarian stimulation are currently used. FSH is the most common drug used for ovulation induction. However, the question is always the same: is the recombinant FSH (rFSH, follitropin alpha or follitropin beta) clinically better than the urinary FSH (uFSH)? The answer is still in debate. The recombinant preparations of rFSH are characterized by a higher degree of purity (99.9%) than uFSH, has no intrinsic LH activity, reduced batch-tobatch variability and there is no risk of infection, making it an alternative to uFSH. Many reports have compared rFSH and uFSH with variable results. Recent meta-analysis indicates that the use of rFSH is to be preferred to uFSH because more oocytes were collected in cycles with better embryo quality and with more pregnancies. With rFSH, the total dose of gonadotrophins required to achieve multifollicular development is lower. No differences were observed in the abortion rate, multiple pregnancy and ovarian hyperstimulation syndrome. Recombinant FSH has a higher cost per ampoule than urinary FSH, but also a higher effectiveness. A recent cost-effectiveness analysis on follitropin alfa compared with uFSH-HP, confirmed that rFSH is the most effective therapy for ovulation induction in assisted reproductive treatments. Role of insulin resistance in reproduction Aguirre W Ecuador Insulin is a peptide hormone that is fundamental in the human’s glucose metabolism, but this hormone also completes other functions which are as important as this one, acting as an essential regulator for the development and growth of tissues, intervening directly in the synthesis of fat proteins and glycogen and even in the expression of genes. Regarding the effect of insulin on folliculogenesis and follicular development, it could be the cause of the ovulatory dysfunction or anovulation which is a characteristic of the hyperandrogenic state, the effect being the sum of increase of androgens in the micro-ovarian environment and alterations in the secretion of LH, acting as a mitogenic factor and increasing the production of growth factors like the IGF-I and II that modifies the ovarian microenvironment which simultaneously leads to the increment of
volume and the development of multiple follicles as well. Prevention of ovarian hyperstimulation syndrome Özörnek H Eurofertil Institute, Nuhkuyusu cad. 90, Altunizade, Istanbul, Turkey Ovarian hyperstimulation syndrome (OHSS) is the gravest complication of controlled ovarian hyperstimulation and is characterized by enlarged ovaries and fluid accumulation in the abdomen after ovulation or egg retrieval. It can be either mild or severe. The mild form occurs in 10%–20% of cycles and results in some discomfort but almost always resolves without complications. The severe form occurs approximately 1–2% of the time. Knowledge and prompt recognition of the risk factors for OHSS are essential for its prevention. Most patients who are at high risk for severe OHSS are identified by closely monitoring ovulation induction cycles with the daily use of ultrasounds and/or serum oestradiol concentrations. There are different strategies for prevention of severe OHSS: coasting, withholding human chorionic gonadotrophin (HCG), decrease in HCG dosage, the use of gonadotrophin-releasing hormone (GnRH) antagonist, the use of GnRH agonist to trigger ovulation, recombinant human LH to trigger ovulation, follicular aspiration, IV albumin administration, HES solution administration, glucocorticoid administration, progesterone for luteal phase support, cryopreservation of embryos and subsequent replacement. There is no ideal protocol for the prevention of OHSS but it will become a rare entity. Complications in assisted reproductive treatment Gholami GH U.S.I. Unita’ Sanitaria Internazionale, Viale Cesare Pavese, 410 00144, Rome, Italy Assisted reproductive treatment procedures carry a small risk both to the mother and the offspring. These risks include ovarian hyperstimulation syndrome, multiple gestation, ectopic pregnancy, spontaneous abortion and preterm birth. Assisted reproduction treatment is an efficacious treatment in subfertile couples. So far little attention has been paid to the safety of assisted reproductive treatment, that is, its adverse events and complications. The consensus meeting on Risks and Complications in Assisted Reproductive Treatment held in Maastricht in May 2002 focused on four topics: multiple pregnancies, long-term effects of assisted reproductive treatment on women, effects of assisted reproductive treatment on offspring, and morbidity and mortality registries
Human implantation and pregnancy: the new frontiers in ART The impact of endometrial polyps on assisted reproductive treatment outcome Isikoglu M Antalya IVF, Antalya, Turkey e-mail: [email protected] Introduction: In order to determine whether the presence of endometrial polyps discovered during ovarian stimulation affect the outcomes of intracytoplasmic sperm injection
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(ICSI) cycles, a retrospective study was carried out in a private assisted reproductive treatment unit. Materials and methods: Medical records of ICSI cycles performed between January 2003 and December 2004 were reviewed. Patients were divided into three groups: (i) group 1, patients with endometrial polyps discovered during the ovarian stimulation (n = 15); (ii) group 2, patients who underwent hysteroscopic polyp resection prior to their ICSI cycle (n = 40); (iii) group 3, patients without polyps ( n = 956).
Recombinant FSH versus urinary FSH Caserta D, Marci R, Moscarini M Dipartimento di Scienze Ginecologiche, Perinatologia e Puericultura, University of Rome ‘La Sapienza’, Italy Infertility affects approximately 20–25% of couples. Ovarian stimulation is a standard practice. Many drug protocols based on gonadotrophin-releasing hormone agonists or antagonists for pituitary down-regulation and on FSH for ovarian stimulation are currently used. FSH is the most common drug used for ovulation induction. However, the question is always the same: is the recombinant FSH (rFSH, follitropin alpha or follitropin beta) clinically better than the urinary FSH (uFSH)? The answer is still in debate. The recombinant preparations of rFSH are characterized by a higher degree of purity (99.9%) than uFSH, has no intrinsic LH activity, reduced batch-tobatch variability and there is no risk of infection, making it an alternative to uFSH. Many reports have compared rFSH and uFSH with variable results. Recent meta-analysis indicates that the use of rFSH is to be preferred to uFSH because more oocytes were collected in cycles with better embryo quality and with more pregnancies. With rFSH, the total dose of gonadotrophins required to achieve multifollicular development is lower. No differences were observed in the abortion rate, multiple pregnancy and ovarian hyperstimulation syndrome. Recombinant FSH has a higher cost per ampoule than urinary FSH, but also a higher effectiveness. A recent cost-effectiveness analysis on follitropin alfa compared with uFSH-HP, confirmed that rFSH is the most effective therapy for ovulation induction in assisted reproductive treatments. Role of insulin resistance in reproduction Aguirre W Ecuador Insulin is a peptide hormone that is fundamental in the human’s glucose metabolism, but this hormone also completes other functions which are as important as this one, acting as an essential regulator for the development and growth of tissues, intervening directly in the synthesis of fat proteins and glycogen and even in the expression of genes. Regarding the effect of insulin on folliculogenesis and follicular development, it could be the cause of the ovulatory dysfunction or anovulation which is a characteristic of the hyperandrogenic state, the effect being the sum of increase of androgens in the micro-ovarian environment and alterations in the secretion of LH, acting as a mitogenic factor and increasing the production of growth factors like the IGF-I and II that modifies the ovarian microenvironment which simultaneously leads to the increment of
volume and the development of multiple follicles as well. Prevention of ovarian hyperstimulation syndrome Özörnek H Eurofertil Institute, Nuhkuyusu cad. 90, Altunizade, Istanbul, Turkey Ovarian hyperstimulation syndrome (OHSS) is the gravest complication of controlled ovarian hyperstimulation and is characterized by enlarged ovaries and fluid accumulation in the abdomen after ovulation or egg retrieval. It can be either mild or severe. The mild form occurs in 10%–20% of cycles and results in some discomfort but almost always resolves without complications. The severe form occurs approximately 1–2% of the time. Knowledge and prompt recognition of the risk factors for OHSS are essential for its prevention. Most patients who are at high risk for severe OHSS are identified by closely monitoring ovulation induction cycles with the daily use of ultrasounds and/or serum oestradiol concentrations. There are different strategies for prevention of severe OHSS: coasting, withholding human chorionic gonadotrophin (HCG), decrease in HCG dosage, the use of gonadotrophin-releasing hormone (GnRH) antagonist, the use of GnRH agonist to trigger ovulation, recombinant human LH to trigger ovulation, follicular aspiration, IV albumin administration, HES solution administration, glucocorticoid administration, progesterone for luteal phase support, cryopreservation of embryos and subsequent replacement. There is no ideal protocol for the prevention of OHSS but it will become a rare entity. Complications in assisted reproductive treatment Gholami GH U.S.I. Unita’ Sanitaria Internazionale, Viale Cesare Pavese, 410 00144, Rome, Italy Assisted reproductive treatment procedures carry a small risk both to the mother and the offspring. These risks include ovarian hyperstimulation syndrome, multiple gestation, ectopic pregnancy, spontaneous abortion and preterm birth. Assisted reproduction treatment is an efficacious treatment in subfertile couples. So far little attention has been paid to the safety of assisted reproductive treatment, that is, its adverse events and complications. The consensus meeting on Risks and Complications in Assisted Reproductive Treatment held in Maastricht in May 2002 focused on four topics: multiple pregnancies, long-term effects of assisted reproductive treatment on women, effects of assisted reproductive treatment on offspring, and morbidity and mortality registries
Human implantation and pregnancy: the new frontiers in ART The impact of endometrial polyps on assisted reproductive treatment outcome Isikoglu M Antalya IVF, Antalya, Turkey e-mail: [email protected] Introduction: In order to determine whether the presence of endometrial polyps discovered during ovarian stimulation affect the outcomes of intracytoplasmic sperm injection
12
(ICSI) cycles, a retrospective study was carried out in a private assisted reproductive treatment unit. Materials and methods: Medical records of ICSI cycles performed between January 2003 and December 2004 were reviewed. Patients were divided into three groups: (i) group 1, patients with endometrial polyps discovered during the ovarian stimulation (n = 15); (ii) group 2, patients who underwent hysteroscopic polyp resection prior to their ICSI cycle (n = 40); (iii) group 3, patients without polyps ( n = 956).