34 11 Vol.34 No.11 2014 11 Nov. 2014 Reproduction & Contraception doi: 10.7669/j.issn.0253-3X.2014.11.0892 E-mail: randc_journal@163.com IVF ( 710003) : (H-hMG) - (IVF- ET) : GnRH H-hMG (H-hMG ) (rfsh ) (Gn) hcg () : (29.4 3.2 vs 28.3 3.0 =0.026) H-hMG Gn rfsh hcg rfsh rfsh rfsh rfsh (<0.05) 65.3% 61.7% : rfsh H-hMG : (H-hMG); (rfsh); ; : R711.6 : A : 0253-3X(2014)11-0892-05 IVF (FSH) FSH (LH) FSH ( >10 mm) FSH LH IVF GnRH (GnRH-a) FSH 150 IU FSH LH FSH/LH LH Wely 2003 [1] (hmg) FSH (H-hMG) 75 IU : ; Tel: +86-18602991568; E-mail: shijuanzi@126.com FSH 10 IU hcg hcg LH α LH 1 IU hcg 6~7 IU LH 31 h LH 13 h hcg LH LH [2] FSH(rFSH) H-hMG 1 1.1 2014.01.01~2014.04.30 IVF : 38 ; GnRH-a ; HhMG(H-hMG ) rfsh(rfsh ) : (EMs) ; 892
(AFC) 5 1.2 21 ( ): AFC>8 0.1 mg/d AFC 8 0.05 mg/d 14 d Gn 0.05 mg/d : FSH 5 IU/L; LH 5 IU/L; E2 50 pg/ml; 5 mm; 5 mm 1.3 Gn H-hMG H-hMG( )150~225 IU/d rfsh rfsh( )150~225 IU/d 5 Gn <10 mm E2<300 pg/ml Gn hcg 1.4 hcg >17 mm >14 mm 60% (rhcg )250 μg 36 h IVF >20 B 1.5 12~14 d β-hcg β-hcg 5 IU/L 35 d B (<0.01) 2 2.3 3 rfsh (<0.05) rfsh (<0.01) (>0.05) (>0.05) rfsh 49 7 1 (x s) Table 1 Comparison of the patients baseline characteristics between two groups Index H-hMG group rfsh group (n) No. of cycles ( ) 29.4 3.2 28.3 3.0 0.026 Age (year) (24~38) (21~37) ( ) 3.8 2.4 3.6 2.0 0.486 Infertility duration (a) (1~10) (0.5~12) 22.4 2.9 22.1 3.2 0.581 BMI (kg/m 2 ) FSH 6.5 1.9 6.3 1.9 0.466 Basal FSH (miu/ml) AFC (n) 14.4 5.1 15.8 5.0 0.059 COS 21.1 (12/) 27.9 (39/) Incidence of COS (%) 1.6 SSS16.0 (x s) (%) t χ 2 <0.05 2 2.1 FSH (>0.05) rfsh 2.2 COS H-hMG 1 H-hMG Gn rfsh (<0.01) hcg 2 (x s) Table 2 Comparison of the patients ovarian stimulation characteristics between two groups Index H-hMG group rfsh group n Gn 2 066.3 7.5 1 731.5 405.0 <0.001 Total dosage of Gn (IU) 9.7 1.2 9.0 1.0 <0.001 Duration of Gn used (d) hcg Day of hcg injection E2 5 446.0 2 760.5 6 733.0 3 382.3 0.011 E2 peak (pg/ml) (ng/ml) 0.93 0.40 1.13 0.40 0.001 LH (IU) 2.3 1.2 2.0 1.1 0.165 893
() 2 2 1 1 1 3 (x s) Table 3 The patients clinical outcomes Index H-hMG group rfsh group n 14.0 (8/) 40.0 (56/) / Rate of cancellation cycles (%) 14.0 (8/) 35.0 (49/) 0.003 Cancellation rate due to (%) hcg 14 mm 13.2 5.2 16.0 5.4 0.001 No. of follicles with diameter size 14 mm on hcg injection day 12.6 6.4 17.8 7.9 <0.001 No. of oocyte retrieval (n) 11.4 2.3 11.0 2.1 0.381 Endometrial thickness (mm) 1.8 0.4 1.7 0.5 0.151 Embryo transfer number (n) 75.0 (5/743) 77.3 (1 922/2 487) 0.190 Fertilization rate (%) 69.9 (355/508) 61.2 (1 151/1 881) <0.001 Embryo available rate (%) 39.8 (27/48) Implantation rate (%) 65.3 (32/49) 42.3 (60/142) 60.7 (51/84) 0.710 0.598 / Clinical pregnancy rate per embryo transfer cycle (%) 3 LH >10 mm FSH / [1] (LH/CG ) 5 mm LH GnRH FSH LH [2] FSH LH [3] Balasch LH [4] LH 2008 O Dea [5] LH<1.2 IU/L LH LH>1.2 IU/L FSH LH E2 FSH LH (ART) [67] H-hMG Gn H-hMG COS H-hMG Gn LH LH LH FSH hcg E2 [8] H-hMG H-hMG rfsh [9] AFC H-hMG 6 d 1~2 AFC>5 Gn E2 Gn HhMG rfsh Gn 6 H-hMG FSH LH 1 1 1.5~2 1 rfsh? AFC H-hMG [8] H-hMG rfsh rfsh (69.9% vs 61.2%) Meta [10] hmg(uhmg) (COH) LH FSH 894
[9] hcg H-hMG E2 820 pmol/l rfsh 663 mmol/l rfsh [11] ART LH [12] H-hMG hcg : ; 1 (insulin-like growth factor-binding protein-1 IGFB- 1) (vascular endothelial growth factor VEGF) [1314] rfsh hcg H-hMG [1516] H-hCG rfsh H-hMG IVF rfsh H-hMG hcg E2 AFC rfsh ; AFC COS H-hMG [1] Jeppesen JV Kristensen SG Niesen ME et al. LH-receptor gene expression in human granulosa and cumulus cells from antral and preovulatory follicles. JCEM 2012 97(8): e1524-31. [2] Balasch J Fábregues F Casamitjana R et al. A pharmacokinetic and endocrine comparison of recombinant follicle-stimulating hormone and human menopausal gonadotrophin in polycystic ovary syndrome. Reprod Biomed Online 2003 6 (3):296-301. [3] Ferrell RJ O Connor KA Holman DJ et al. Monitoring reproductive aging in a 5-year prospective study: aggregate and individual changes in luteinizing hormone and follicle stimulating hormone with age. Menopause 2007 14(1):29-37. [4] Balasch J Fabregues F. Is luteinizing hormone needed for optimal ovulation induction? Curr Opin Obstet Gynecol 2002 14(3):265-74. [5] O Dea L O Brien F Currie K et al. Follicular development induced by recombinant luteinizing hormone (LH) and follicle stimulating hormone (FSH) in anovulatory women with LH and FSH deficiency: evidence of a threshold effect. Curr Med Res Opin 2008 24(10):2785-93. [6] Van Wely M Kwan I Burt AL. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. A Cochrane review. Hum Reprod Update 2012 18(2):111. [7] Andersen AN Devroey Arce JC. Clinical outcome following stimulation with highly purified hmg or recombinant FSH in patients undergoing IVF: a randomized assessorblind controlled trial. Hum Reprod 2006 21(12):3217-27. [8] Figen TA Seckin B Onalan G. Human menopausal gonadotropin versus recombinant FSH in polycystic ovary syndrome patients undergoing in vitro fertilization. Int J Fertil Steril 2013 6(4):238-43. [9] Hompes G Broekmans FJ Hoozemans DA. Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization intracytoplasmic sperm injection patients. Fertil Steril 2008 89(6):1685-93. [10] Arri C Masoud A Deepti C et al. Urinary hmg verse recombinant FSH for controlled ovarian hyperstimulation following an agonist long down-regulation protocol in IVF or ICSI treatment: a systematic review and mete-analysis. Hum Reprod 2008 23(2):310-5. [11] AndreaW Santigo M Werner B et al. The impact of LH containing gonadotropins on diploid rates in preimplantation embryos: long protocol stimulation. Hum Reprod 2008 23(3):499-503. [12] McGee EA Hsueh AJ. Initial and cyclic recruitment of ovarian follicles. Endocr Rev 2000 21(2):200-14. [13] Filicori M Fazleabas AT Huhtaniemi I et al. Novel concepts of human chorionic gonadotropin: reproductive system interactions and potential in the management of infertility. Fertil Steril 2005 84(2):275-84. 895
[14] Durnerin G Erb K Fleming R et al. Effects of recombinant LH treatment on folliculogenesis and responsiveness to FSH stimulation. Hum Reprod 2008 23(2):421-6. [15] latteau Nyboe Andersen A Loft A et al. Highly purified hmg versus recombinant FSH for ovarian stimulation in IVF cycles. Reprod Biomed Online 2008 17(2):190-8. [16] Ziebe S Lundin K Janssens R et al. Influence of ovarian stimulation with H-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF. Hum Reprod 2007 22(9):2404-13. (2014 9 12 ) reliminary Exploration of Comparing High urified hmg with rfsh in Controlled Ovarian Hyperstimulation of IVF Cycles Li TIAN Na LI Juan-zi SHI Hai-yan BAI (Center for Assisted Reproduction Technology Maternal & Child Health Care Hospital of Shanxi rovince Xi an 710003) ABSTRACT Objective: To evaluate the efficacy of highly purified human menopausal gonadotrophin (HhMG) in patients with normal ovarian reservation in controlled ovarian hyperstimulation (COH) during IVF cycles. Methods: A retrospective study was carried out in our IVF center. Those patients with normal ovarian reservation who were planned to undergo GnRH-a long protocol treatment were enrolled in this study. Totally patients were performed in H-hMG group and patients were performed in recombinant FSH (rfsh) group. The main observational outcomes included total dosage of Gn duration of ovarian stimulation the number of oocyte retrieved implantation rate clinical pregnancy rate serum estradiol (E2) level and progesterone () level on hcg injection day and cancellation rate due to ovarian hyperstimulation syndrome () risk. Results: Compared with rfsh patients in H-hMG group was older (29.4 3.2 years vs 28.3 3.0 years =0.026). Total Gn dosage was higher in H-hM group than in rfsh group. Also in H-hMG group patients need more time for total stimulation duration. On the day of hcg injection serum E2 and levels were lower in H-hMG group. The number of oocyte retrieved was less in H-hMG group but in this group patients had higher embryo available rate than that in rfsh group. H-hMG group experienced lower cancellation rate to prevent. Though higher clinical pregnancy rate showed in H-hMG group (65.3% vs 61.7%) there was no significantly statistic difference between the two groups. Conclusion: Compared with rfsh H-hMG needs higher dosage or longer duration for ovary stimulation but has lower risk higher available embryo rate and a tendency of higher clinical pregnancy rates. Key words: highly purified human menopausal gonadotrophin (H-hMG); recombinant FSH (rfsh); ovarian hyperstimulation; clinical pregnancy rate 896