A comparative review of ovulation and pregnancy rates by gonadotrophin preparations in women with group 1 who anovulatory infertility

Abstract

OBJECTIVE: The aim of this study was to compare ovulation and pregnancy rates in a large cohort of women with Type I WHO anovulatory infertility undergoing ovulation induction (OI) with gonadotrophin preparations containing varying amounts of luteinizing hormone (LH). DESIGN: A retrospective study of patients with Type I WHO anovulatory infertility undergoing gonadotrophin OI at our institution between 1981 and 2006. MATERIALS AND METHODS: Gonadotrophin preparations included human pituitary gonadotrophin (hPG), human menopausal gonadotrophin (hMG), purified urinary follicle stimulating hormone (uFSH) and highly purified urinary FSH (hpuFSH), and recombinant FSH (rFSH). All patients were entered into a database (Foxpro). Statistical analysis using SPSS was performed. RESULTS: A total of 223 patients undergoing 731 cycles of OI with gonadotrophins were analyzed. The mean patient age was 30 years (range 19-49). The mean FSH usage per cycle was 1413 units. Overall, ovulation and pregnancy rates per cycle were 81.5% and 22.1% respectively with a cumulative pregnancy rate of 60% per woman. The ovulation rate per cycle was significantly higher with purified and highly purified urinary FSH (90%) and rFSH (89%) compared to hMG (59%) and hPG (41%) (p<0.0001). However, there was no difference in pregnancy rates per ovulatory cycle between the different gonadotrophin preparations. CONCLUSIONS: The belief that LH is crucial for folliculogenesis has become increasingly accepted; in particular, supplementation of LH in hypogonadotrophic women undergoing OI. The use of recombinant FSH, purified and highly purified urinary FSH for OI in this large series of patients with WHO Type I anovulatory infertility, was more effective than other gonadotrophin preparations in achieving ovulation and equally as effective in terms of pregnancy. These findings question the hypothesis that additional LH is required for OI in WHO Type I patients.