Efficacy of low dose purified FSH in ovulation induction following pituitary desensitization in polycystic ovarian syndrome.

2.50
Hdl Handle:
http://hdl.handle.net/10541/99787
Title:
Efficacy of low dose purified FSH in ovulation induction following pituitary desensitization in polycystic ovarian syndrome.
Authors:
Buckler, H M; Critchley, H O; Cantrill, J A; Shalet, Stephen M; Anderson, D C; Robertson, W R
Abstract:
OBJECTIVES: We evaluated the efficacy of ovulation induction using purified FSH in either low dose or conventional dosage in patients with polycystic ovarian syndrome. We assessed whether gonadotrophin measurement by radioimmunoassay or immunoradiometric assay is a better indicator of whether pituitary desensitization with a GnRH agonist (Zoladex) has occurred. DESIGN: Two different protocols were used. Pituitary desensitization was carried out with a GnRH agonist (Zoladex, ICI Pharmaceuticals UK). The patients were then randomized into one of two treatment groups. Conventional dose protocol: Patients commenced with a daily FSH (Metrodin, Serono Laboratories Ltd, UK) dose of 75 units for at least 7 days. The FSH dose was then increased, if necessary, based on ultrasound scans and plasma oestradiol (E2) levels in 75-unit increments. Low dose protocol: The same protocol was used except that the starting dose of FSH was 37.5 units daily with increments of 37.5 units. RESULTS: Low dose protocol (six patients, six cycles). There was a high incidence of multiple follicular development (10.3 +/- 5.6 (+/- SD) follicles, 5.0 +/- 3.8 follicles > 14 mm in diameter). Three cycles resulted in ovulation, one was anovulatory and two patients underwent gamete intrafallopian transfer due to multiple follicular development. Conventional dose protocol (seven patients, eight cycles). Again there was multiple follicular development (10.1 +/- 8.6 follicles, 2.0 +/- 2.3 > 14 mm). Three cycles were ovulatory, one anovulatory, three abandoned due to multiple follicular development and one underwent gamete intrafallopian transfer with the development of severe hyperstimulation necessitating steroid therapy. There was no difference between the two protocols in the number of days of FSH administration (low dose protocol 26 +/- 6.5, conventional dose protocol 23 +/- 8.1 days), the total number of units of FSH given per patient was 2844 +/- 1816 vs 2635 +/- 1726. The peak E2 level (pmol/l) during FSH treatment was 3193 +/- 662 vs 2389 +/- 3099 and the rate of increase in the FSH dose in ampoules of Metrodin per day was 0.058 +/- 0.03 vs 0.057 +/- 0.03. All patients were 'downregulated' (E2 < 70 pmol/l) prior to ovulation induction. However, gonadotrophin levels (IU/l) were 4.3 +/- 1.5 (LH) and 2.8 +/- 1.2 (FSH) by radioimmunoassay and LH was unchanged throughout FSH treatment whereas LH measured by immunoradiometric assay was < 1.0 IU/l prior to ovulation induction and remained so throughout. The mean LH radioimmunoassay to immunoradiometric assay ratio was 6.2 +/- 2.1. CONCLUSIONS: We conclude that regardless of the starting dose the use of pure FSH in patients with polycystic ovarian syndrome whose LH has been completely down regulated may be associated with multiple follicular development and a poor outcome. LH measured by radioimmunoassay is not a good indicator of whether pituitary densensitization has occurred but LH measured by immunoradiometric assay appears to be. These results strongly suggest that a basic minimum amount of LH is necessary for normal ovulatory development.
Affiliation:
Department of Medicine, University of Manchester, Hope Hospital, UK.
Citation:
Efficacy of low dose purified FSH in ovulation induction following pituitary desensitization in polycystic ovarian syndrome. 1993, 38 (2):209-17 Clin. Endocrinol. (Oxf)
Journal:
Clinical Endocrinology
Issue Date:
Feb-1993
URI:
http://hdl.handle.net/10541/99787
DOI:
10.1111/j.1365-2265.1993.tb00995.x
PubMed ID:
8435902
Type:
Article
Language:
en
ISSN:
0300-0664
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorBuckler, H Men
dc.contributor.authorCritchley, H Oen
dc.contributor.authorCantrill, J Aen
dc.contributor.authorShalet, Stephen Men
dc.contributor.authorAnderson, D Cen
dc.contributor.authorRobertson, W Ren
dc.date.accessioned2010-05-25T14:01:32Z-
dc.date.available2010-05-25T14:01:32Z-
dc.date.issued1993-02-
dc.identifier.citationEfficacy of low dose purified FSH in ovulation induction following pituitary desensitization in polycystic ovarian syndrome. 1993, 38 (2):209-17 Clin. Endocrinol. (Oxf)en
dc.identifier.issn0300-0664-
dc.identifier.pmid8435902-
dc.identifier.doi10.1111/j.1365-2265.1993.tb00995.x-
dc.identifier.urihttp://hdl.handle.net/10541/99787-
dc.description.abstractOBJECTIVES: We evaluated the efficacy of ovulation induction using purified FSH in either low dose or conventional dosage in patients with polycystic ovarian syndrome. We assessed whether gonadotrophin measurement by radioimmunoassay or immunoradiometric assay is a better indicator of whether pituitary desensitization with a GnRH agonist (Zoladex) has occurred. DESIGN: Two different protocols were used. Pituitary desensitization was carried out with a GnRH agonist (Zoladex, ICI Pharmaceuticals UK). The patients were then randomized into one of two treatment groups. Conventional dose protocol: Patients commenced with a daily FSH (Metrodin, Serono Laboratories Ltd, UK) dose of 75 units for at least 7 days. The FSH dose was then increased, if necessary, based on ultrasound scans and plasma oestradiol (E2) levels in 75-unit increments. Low dose protocol: The same protocol was used except that the starting dose of FSH was 37.5 units daily with increments of 37.5 units. RESULTS: Low dose protocol (six patients, six cycles). There was a high incidence of multiple follicular development (10.3 +/- 5.6 (+/- SD) follicles, 5.0 +/- 3.8 follicles > 14 mm in diameter). Three cycles resulted in ovulation, one was anovulatory and two patients underwent gamete intrafallopian transfer due to multiple follicular development. Conventional dose protocol (seven patients, eight cycles). Again there was multiple follicular development (10.1 +/- 8.6 follicles, 2.0 +/- 2.3 > 14 mm). Three cycles were ovulatory, one anovulatory, three abandoned due to multiple follicular development and one underwent gamete intrafallopian transfer with the development of severe hyperstimulation necessitating steroid therapy. There was no difference between the two protocols in the number of days of FSH administration (low dose protocol 26 +/- 6.5, conventional dose protocol 23 +/- 8.1 days), the total number of units of FSH given per patient was 2844 +/- 1816 vs 2635 +/- 1726. The peak E2 level (pmol/l) during FSH treatment was 3193 +/- 662 vs 2389 +/- 3099 and the rate of increase in the FSH dose in ampoules of Metrodin per day was 0.058 +/- 0.03 vs 0.057 +/- 0.03. All patients were 'downregulated' (E2 < 70 pmol/l) prior to ovulation induction. However, gonadotrophin levels (IU/l) were 4.3 +/- 1.5 (LH) and 2.8 +/- 1.2 (FSH) by radioimmunoassay and LH was unchanged throughout FSH treatment whereas LH measured by immunoradiometric assay was < 1.0 IU/l prior to ovulation induction and remained so throughout. The mean LH radioimmunoassay to immunoradiometric assay ratio was 6.2 +/- 2.1. CONCLUSIONS: We conclude that regardless of the starting dose the use of pure FSH in patients with polycystic ovarian syndrome whose LH has been completely down regulated may be associated with multiple follicular development and a poor outcome. LH measured by radioimmunoassay is not a good indicator of whether pituitary densensitization has occurred but LH measured by immunoradiometric assay appears to be. These results strongly suggest that a basic minimum amount of LH is necessary for normal ovulatory development.en
dc.language.isoenen
dc.subject.meshAdult-
dc.subject.meshDrug Administration Schedule-
dc.subject.meshFemale-
dc.subject.meshFollicle Stimulating Hormone-
dc.subject.meshGoserelin-
dc.subject.meshHumans-
dc.subject.meshImmunoradiometric Assay-
dc.subject.meshLuteinizing Hormone-
dc.subject.meshOvulation Induction-
dc.subject.meshPituitary Gland-
dc.subject.meshPolycystic Ovary Syndrome-
dc.subject.meshSecretory Rate-
dc.titleEfficacy of low dose purified FSH in ovulation induction following pituitary desensitization in polycystic ovarian syndrome.en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, University of Manchester, Hope Hospital, UK.en
dc.identifier.journalClinical Endocrinologyen

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