Use Of Human Menopausal Gonadotropin Research Articles

A PROSPECTIVE STUDY ON THE VALUE OF MONITORING EXOGENOUS SOURCED SERUM HUMAN CHORIONIC GONADOTROPIN LEVELS DURING IVF STIMULATION: LESSONS LEARNED FROM 2,257 CYCLES

Adding an LH component to IVF stimulation has previously been reported to improve retrieval outcomes in certain populations, when compared to follicle stimulating hormone (FSH) alone. Consequently, IVF cycles routinely utilize human chorionic gonadotropin (hCG) as a means of luteinizing hormone (LH) replacement throughout stimulation, either through use of human menopausal gonadotropin (hMG) or low dose hCG (ldHCG). The influence of these medications is reflected in serum hCG levels. The aim of this study is to determine if serum hCG levels during the follicular phase of IVF stimulation are associated with improved embryologic outcomes.

Evaluation of Endometrial Angiogenesis in Mice Uterus Before Implantation in Natural Cycles Followed by Use of Human Menopausal Gonadotropin - Human Chorionic Gonadotropin Drugs and Epigallocatechin Gallate.

Background:Angiogenesis plays a major role in endometrial receptivity and thickening of the endometrium immediately before implantation. The aim of the present work was to evaluate the antiangiogenic properties of epigallocatechin-3-gallate (EGCG) from green tea in angiogenesis of endometrium.Materials and Methods:In this study, forty adult female NMARI mice randomly divided into four groups. Control group received vehicle; human menopausal gonadotropin/human chorionic gonadotropin (HMG/HCG) group received 7.5 IU HMG intraperitoneal (IP) and 48 h later 7.5 IU HCG was injected (IP) for ovarian stimulation; HMG/HCG + EGCG group received HMG and HCG in the same manner as the previous group and also received 5 mg/kg EGCG at 0, 24, 48, and 72 h after injection of HMG; and the group EGCG received 5 mg/kg EGCG. A male mouse was kept with two female animals in the same cage for mating. Mice were dissected 96 h after administration of HMG (immediately before implantation) and tissue processing was carried out for the uterine specimens. CD31-positive cells were counted by use of histological and immunohistochemical methods.Results:Angiogenesis in EGCG-treated group was less than that of control and gonadotropin group (P < 0.05). The number of endothelial cells was counted by CD31 marker under a light microscope and showed significant differences between all groups (P < 0.05).Conclusion:EGCG significantly inhibited the angiogenesis in endometrium (in natural cycles) through antiangiogenic effects.

Adjuvant Growth Hormone for Ovulation Induction with Gonadotropins in the Treatment of a Woman with Hypopituitarism

Objective. To report the prestimulation use of adjuvant GH for gonadotropin ovulation induction in a woman with hypopituitarism and GH deficiency who previously failed to respond. Design, Patients, and Measurements. A 31-year-old nulliparous woman presented with hypopituitarism and GH deficiency after failing ovulation induction with high dose gonadotropins. A trial of GH was undertaken for 5 months prior to ovulation induction resulting in normalization of IGF-I levels. Results. Women with hypopituitarism are known to have lower pregnancy rates after ovulation induction with need for higher doses of gonadotropins. A small subset of these patients do not ovulate. This patient had successful ovulation induction and pregnancy with prestimulation GH. Conclusions. This case suggests that the use of adjuvant GH in a GH-deficient patient several months before the use of human menopausal gonadotropin results in ovulation and pregnancy.

Comparison of metaphase II oocytes after stimulation with recombinant follicle-stimulating hormone and urinary follicle-stimulating hormone in a pituitary down-regulation regimen

Comparison of metaphase II oocytes after stimulation with recombinant follicle-stimulating hormone and urinary follicle-stimulating hormone in a pituitary down-regulation regimen

Use of human menopausal gonadotropins (hMG) and Leuprolide Acetate or Ganirelix Acetate in poor responder patients.

Use of human menopausal gonadotropins (hMG) and Leuprolide Acetate or Ganirelix Acetate in poor responder patients.

Does controlled ovarian stimulation (COS) in assisted reproductive technologies with recombined human FSH (r-hFSH) need the use of human menopausal gonadotropin (HMG)?

Objective: The suppression of the endogenous LH secretion after the use of a high dose of GnRH agonist in the common long luteal protocol and the advent of r-h FSH leads to a debate whether it is necessary to add or not exogenous LH during the COS. This study aims to compare the results of ovarian stimulation using r-h FSH alone versus the combination of r-h FSH and the HMG, in order to determine the threshold of the basal level of LH, after down regulation, that would allow to predict if the COS needs LH supplementation to obtain a correct follicular growth, and an appropriate steroidogenesis.

Use of human menopausal gonadotropins in the treatment of endometrial defects associated with recurrent miscarriage: preliminary report

Objective: To test the hypothesis that controlled ovarian stimulation by gonadotropins, which enhances estrogen priming, is of beneficial value in the treatment of endometrial defects associated with recurrent miscarriage. Design: A retrospective, observational, nonrandomized study. Setting: A regional recurrent miscarriage clinic in a teaching hospital. Patient(s): Twenty-one subjects with otherwise unexplained recurrent miscarriage who had retarded endometrial development in the mid–luteal phase. Endometrial biopsies were timed by the luteinizing hormone surge. Intervention(s): Controlled ovarian stimulation using human menopausal gonadotropins and repeat endometrial biopsy in the treatment cycle in 13 subjects. Main Outcome Measure(s): Histological dating of endometrial biopsy in treatment cycles and miscarriage rate in treatment and nontreatment cycles. Result(s): Eleven (85%) of the 13 biopsies in the treatment cycle were found to be normal. The miscarriage rate in the treatment group, 2 of 13, was significantly lower than that in the nontreatment group (7/12) (χ 2 5.0, P<.05). Conclusion(s): In this small series, preliminary experience suggests that controlled ovarian stimulation by human menopausal gonadotropins in the follicular phase is an effective treatment for luteal phase defect associated with recurrent pregnancy loss. There is now a case for a prospective, controlled study to confirm the value of such a treatment.

Evolving patterns of iatrogenic multifetal pregnancy generation: Implications for aggressiveness of infertility treatments

Objective: Our purpose was to assess the changes in multifetal pregnancy generation as a function of utilization of ovulation stimulation and assisted reproductive techniques and to document the relative control of hyperstimulation between the methods. Study design: The methods of infertility treatment, number of fetuses, and outcomes of 220 patients referred for multifetal pregnancy reductioni were compared over three time periods (1986 to 1989, 1991 to 1992, and 1992 to 1993). Clomiphene, human menopausal gonadotropin, and ovulation stimulation wit urofollitropin were compared against gamete intrafallopian transfer, zygote intrafallopian transfer, and in vitro fertilization (assisted reproductive techniques). Results: The proportion of multifetal pregnancies generated by assisted reproductive techniques has steadily risen from 26% in the first two time periods to nearly half in the last 2 years. However, the number and proportion of quintuplet and greater pregnancies from assisted reproductive techniques have steadily fallen while for ovulation stimulation the proportion has remained about one third. Conclusion: Despite considerably increased use and proportionate generation of triplet and quadruplet pregnancies, the incidence of quintuplets has fallen for assisted reproductive techniques while there has been no improvement for ovulation stimulation. Continued, greter vigilance, particularly in the use of human menopausal gonadotropin and urofollitropin, must be emphasized.

Equivalency of human menopausal gonadotropin and follicle-stimulating hormone stimulation after gonadotropin-releasing hormone agonist suppression

This study compares the use of human menopausal gonadotropin (hMG) versus follicle-stimulating hormone (FSH), after gonadotropin-releasing hormone agonist (GnRH-a) suppression for in vitro fertilization. Thirty-seven patients were randomized to ovarian stimulation with either hMG or pure FSH. The GnRH-a leuprolide acetate was administered to all patients beginning in the midluteal phase of the prior cycle and continuing until the day of human chorionic gonadotropin (hCG) administration. There were no significant differences between hMG and FSH cycles with regard to the day of hCG administration, mean peak estradiol levels, number of ampules of medication used, and number of oocytes aspirated, embryos transferred, or pregnancies. We conclude that there is no significant difference between hMG and FSH stimulation when used in conjunction with GnRH-a.

Multiple pregnancies conceived with intrauterine insemination during superovulation: An evaluation of clinical characteristics and monitored parameters of conception cycles

The use of human menopausal gonadotropins to induce superovulation in conjunction with intrauterine insemination as treatment for infertility is associated with an increased incidence of multiple gestation. Identification of clinical characteristics and/or monitored parameters of the stimulation cycles highly associated with multiple gestation would enable cancellation of these cycles. We retrospectively evaluated the clinical profiles and conception cycle characteristics of 48 infertile women undergoing the induction of superovulation and intrauterine insemination. We compared 14 of these women who conceived multiple gestations (eight twins and six triplets) with 34 who conceived singleton gestations. We found no differences between the groups in age, parity, cause or duration of infertility, duration or amount of human menopausal gonadotropin administration, serum estradiol concentrations on the day of human chorionic gonadotropin injection, number of preovulatory-sized follicles, or number of motile sperm inseminated. We conclude that neither the patients' clinical characteristics nor the parameters evaluated in monitoring human menopausal gonadotropin cycles provide information helpful in predicting which superovulation cycles will result in multiple pregnancy.

Septuplet gestation following the use of human menopausal gonadotropin despite intensive monitoring

Despite this good correlation supporting only four follicles, seven gestational sacs developed. The cause is unknown, but oocyte division cannot be ruled out. This case demonstrates that there are no absolute criteria for preventing high multiple pregnancies. While sophisticated cycle tracking using ultrasound and E2 values may alert the clinician to the development of multiple follicles, thus permitting discontinuation of the treatment, this report emphasizes that multiple gestations exceeding the anticipated number of follicles remains a possibility.

The outcome of continued treatment of luteinizing hormone-surged cycles in in vitro fertilization with the use of human menopausal gonadotropin

Over a 2-year period 75 patients were treated for 109 cycles with human menopausal gonadotropin for in vitro fertilization. The occurrence of endogenous luteinizing hormone (LH) surges was monitored by daily blood sampling. Forty-six cycles (42%) showed an endogenous LH surge. Instead of canceling the treatment cycle as other programs do, we proceeded to oocyte collection when the surge was detected. Human chorionic gonadotropin was administered routinely to the "surge" patients as soon as the LH surge was determined. The oocyte collection was carried out around 24 hours after the "surge" blood had been drawn, although the beginning of the endogenous LH surge was unable to be pinpointed. Significantly more immature oocytes, lower fertilization rate, and lower cleavage rate were seen in the "surge" patients than in the "nonsurge" patients. In five "surge" cycles laparoscopy for oocyte collection was canceled, but none was canceled because of premature ovulation detected by the immediately preoperative ultrasonography. In four "surge" cycles no potentially fertilizable egg was recovered. This was not significantly different from that of the "nonsurge" group. The pregnancy rate of the "surge" group (4/41 or 9.8% per laparoscopy and 4/34 of 11.8% per embryo transfer) was not statistically different from that of the "nonsurge" group (7/61 or 11.5% per laparoscopy and 7/56 or 12.5% per embryo transfer). This study presents the possibility of proceeding to oocyte collection, fertilization, embryo transfer, and pregnancy in patients with endogenous LH surge in in vitro fertilization procedures with the use of human menopausal gonadotropin treatment.

Reconstructive pelvic operations for in vitro fertilization

Lysis of adhesions, bilateral salpingectomy, and ovarian suspension were carried out in 54 normal ovulatory patients with long-standing infertility that was associated with severe pelvic adhesions after multiple laparotomies for reimplantation of the fallopian tubes, salpingostomy, lysis of adhesions, or severe endometriosis. Ovulation was induced in 39 patients after laparotomy for in vitro fertilization, with the use of human menopausal gonadotropin, pure follicle-stimulating hormone, and human chorionic gonadotropin. Oocyte retrieval by laparoscopy was accomplished in 37 patients, and embryo transfer was carried out in 36. Pregnancy after in vitro fertilization and embryo transfer occurred in 14 patients. Although severe adhesions recurred in four patients, a significant improvement was obtained after the procedure in the others.

Use of human menopausal gonadotropin for the induction of ovulation

Experience with the use of human menopausal gonadotropins for the induction of ovulation is reported in 62 patients. Twenty-six pregnancies were achieved. Twenty-one pregnancies occurred during the first 3 months of treatment, suggesting that the chances for successful therapy decline significantly after this initial period. While the over-all beneficial effect to specific patients is undeniable, selection of this treatment requires a careful consideration of pretreatment diagnosis, risks involved, and also a natural history in terms of spontaneous remission of the functional anomalies to be treated.

The Use of Human Menopausal Gonadotropins as a Test for the Differentiation of Primary Amenorrhea

The Use of Human Menopausal Gonadotropins as a Test for the Differentiation of Primary Amenorrhea