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Endocrine profile in serum and follicular fluid differs after ovarian stimulation with highly purified menotrophin (HP-hMG) or recombinant follicle-stimulating hormone (FSH) in in vitro fertilisation (IVF) patients1



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.



  1. Smitz et al. Hum Reprod. 2007;(3):676–687.
  2. Andersen A N, et al. Hum Reprod. 2006;21:3217–3227.

Job Code: UK-MR-2300038 - Date of preparation: July 2023


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