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Smitz et al. Hum Reprod. 2007;(3):676–687: A comparison of serum and follicular fluid endocrine profiles following ovarian stimulation
Trial type: Randomised, open-label, assessor-blind, parallel-group, multicentre, multinational study.
Participants: 731 women undergoing IVF.
Primary endpoint: Ongoing-pregnancy rates.
Sub-analysis: Evaluation of serum and follicular levels of FSH, luteinising hormone (LH), human chorionic gonadotrophin (hCG), androstenedione, testosterone and oestradiol.
Comparator agents: Highly purified menotrophin (HP-hMG) (n=363) and recombinant FSH (rFSH) (n=368).
Protocol: Long gonadotropin-releasing hormone (GnRH) agonist down regulation; blood was collected before, during and after stimulation. Fluid was collected from follicles ≥17 mm.
Clinical endpoints:2 Clinical pregnancy rate, endometrial status, follicular development, oocyte retrieval, fertilisation rate, embryo quality, endocrine profile in serum and follicular fluid and treatment efficiency.
Hormone levels after starting stimulation: Serum androstenedione, total testosterone and free androgen index (FAI) were higher (p<0.001) with HP-hMG than with rFSH.
Hormone levels at the end of stimulation: Serum oestradiol was higher (p=0.031) with HP-hMG, whereas progesterone was higher (p<0.001) with rFSH, even after adjusting for ovarian response. Serum LH was not different between treatments.
hCG levels: Mean mid- and end-follicular hCG levels in the HP-hMG group were 2.5 and 2.9 IU/l, respectively.
Follicular fluid analysis: Follicular fluid levels of FSH, LH, hCG, androstenedione, testosterone, free androgen index (FAI) and oestradiol and ratios of oestradiol:androstenedione, oestradiol:total testosterone and oestradiol:progesterone were higher (p<0.001) with HP-hMG, whereas progesterone was higher (p<0.001) with rFSH.
Major differences in serum and follicular fluid endocrine profile exist after stimulation with HP-hMG or rFSH. Exogenous LH activity induces a differential endocrine environment influencing oocyte quantity and quality, which may be of relevance for clinical outcome.
Job Code: UK-MR-2300038 - Date of preparation: July 2023