RESUMEN
Controlled ovarian stimulation has become an integral part of a high complexity infertility treatment. Treatment options with recombinant gonadotrophins add more to knowledge on folliculogenesis and ovarian steroidogenesis. Therefore, a literature search was conducted in the following data bases: Medline, Scielo and PubMed. The descriptors/ key words used were ovarian stimulation, in vitro fertilization, recombinant luteinizing hormone, supplementation LH. The aim of this study was to review the available literature and to assess the benefits of using recombinant luteinizing hormone associated with recombinant follicle stimulating hormone in different populations who have undergone assisted reproduction procedures.
Asunto(s)
Fertilización In Vitro , Infertilidad Femenina/terapia , Hormona Luteinizante/uso terapéutico , Síndrome de Hiperestimulación Ovárica/tratamiento farmacológico , Proteínas Recombinantes/uso terapéutico , Femenino , HumanosRESUMEN
Gonadotropin therapy plays an integral role in ovarian stimulation for infertility treatments. Efforts have been made over the last century to improve gonadotropin preparations. Undoubtedly, current gonadotropins have better quality and safety profiles as well as clinical efficacy than earlier ones. A major achievement has been introducing recombinant technology in the manufacturing processes for follicle-stimulating hormone, luteinizing hormone, and human chorionic gonadotropin. Recombinant gonadotropins are purer than urine-derived gonadotropins, and incorporating vial filling by mass virtually eliminated batch-to-batch variations and enabled accurate dosing. Recombinant and fill-by-mass technologies have been the driving forces for launching of prefilled pen devices for more patient-friendly ovarian stimulation. The most recent developments include the fixed combination of follitropin alfa + lutropin alfa, long-acting FSH gonadotropin, and a new family of prefilled pen injector devices for administration of recombinant gonadotropins. The next step would be the production of orally bioactive molecules with selective follicle-stimulating hormone and luteinizing hormone activity.
Asunto(s)
Gonadotropina Coriónica/uso terapéutico , Hormona Folículo Estimulante/uso terapéutico , Hormona Luteinizante/uso terapéutico , Inducción de la Ovulación/métodos , Femenino , Humanos , Infertilidad/terapia , Inducción de la Ovulación/tendenciasRESUMEN
Gonadotropin therapy plays an integral role in ovarian stimulation for infertility treatments. Efforts have been made over the last century to improve gonadotropin preparations. Undoubtedly, current gonadotropins have better quality and safety profiles as well as clinical efficacy than earlier ones. A major achievement has been introducing recombinant technology in the manufacturing processes for follicle-stimulating hormone, luteinizing hormone, and human chorionic gonadotropin. Recombinant gonadotropins are purer than urine-derived gonadotropins, and incorporating vial filling by mass virtually eliminated batch-to-batch variations and enabled accurate dosing. Recombinant and fill-by-mass technologies have been the driving forces for launching of prefilled pen devices for more patient-friendly ovarian stimulation. The most recent developments include the fixed combination of follitropin alfa + lutropin alfa, long-acting FSH gonadotropin, and a new family of prefilled pen injector devices for administration of recombinant gonadotropins. The next step would be the production of orally bioactive molecules with selective follicle-stimulating hormone and luteinizing hormone activity.
Asunto(s)
Femenino , Humanos , Gonadotropina Coriónica/uso terapéutico , Hormona Folículo Estimulante/uso terapéutico , Hormona Luteinizante/uso terapéutico , Inducción de la Ovulación/métodos , Infertilidad/terapia , Inducción de la Ovulación/tendenciasRESUMEN
This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocyets retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further.
Asunto(s)
Fertilización In Vitro , Hormona Folículo Estimulante/uso terapéutico , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Hormona Luteinizante/uso terapéutico , Inducción de la Ovulación , Estradiol/sangre , Femenino , Fertilización In Vitro/normas , Hormona Folículo Estimulante/genética , Humanos , Hormona Luteinizante/genética , Hormona Luteinizante/normas , Embarazo , Índice de Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Proteínas Recombinantes/uso terapéutico , Inyecciones de Esperma Intracitoplasmáticas/normas , Resultado del TratamientoRESUMEN
PURPOSE: to compare the efficacy of recombinant LH supplementation for controlled ovarian stimulation in recombinant FSH and GnRH-agonist protocol. METHODS: Search strategies included on-line surveys of databases. The fixed effects model was used for odds ratio and effect size (weighted mean difference). Four trials fulfilled the inclusion criteria. RESULTS: a fewer days of stimulation (p<0.0001), a fewer total amount of r-FSH administered (p<0.0001) and a higher serum estradiol levels on the day of hCG administration (p<0.0001) were observed for the r-LH supplementation protocol. However, differences were not observed in number of oocyte retrieved, number of mature oocytes, clinical pregnancy per oocyte retrieval, implantation and miscarriage rates. CONCLUSIONS: more randomized controlled trials are necessary before evidence-based recommendations regarding exogenous LH supplementation in ovarian stimulation protocols with FSH and GnRH-agonist for assisted reproduction treatment can be provided.
Asunto(s)
Hormona Folículo Estimulante/uso terapéutico , Hormona Liberadora de Gonadotropina/agonistas , Hormona Luteinizante/metabolismo , Inducción de la Ovulación/métodos , Proteínas Recombinantes/uso terapéutico , Femenino , Fertilización In Vitro , Hormona Folículo Estimulante/genética , Hormona Folículo Estimulante/metabolismo , Humanos , Hormona Luteinizante/genética , Hormona Luteinizante/uso terapéutico , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Resultado del TratamientoRESUMEN
El presente estudio muestra que hay en la actualidad cierta tendencia a asignar mayor valor a la observación del crecimiento folicular por ultrasonido que a los niveles hormonales "per se". Sin embargo, la apreciación del crecimiento es sólo parte del fenómeno de desarrollo y madurez ovárica, por lo cual la vigilancia con monitor hormonal de la respuesta ovárica sigue teniendo un papel preponderante en las Clínicas de Reproducción Asistida. Los niveles basales principalmente de FSH y en menor grado los de LH, correlacionan inversamente con la cantidad de ovocitos recuperados. Los valores de estradiol deben interpretarse con un punto de referencia fijo, como el día de la administración de HCG y se aprecia una relación directa entre niveles de estradiol y ovocitos capturados; sin embargo, es de mayor utilidad valorar el comportamiento de la curva de estradiol, con el conocimiento de que el pronóstico para buenas tasas de captura mejora al presentarse valores ascendentes y por arriba de los 700 pg en el día de la administración de HCG.