Human menopausal gonadotropin versus recombinant FSH in polycystic ovary syndrome patients undergoing in vitro fertilization

We aimed to compare human menopausal gonadotropin [hMG] and recombinant follicle-stimulating hormone [r FSH] with respect to clinical outcomes and the development of ovarian hyperstimulation syndrome [OHSS] for patients with polycystic ovary syndrome [PCOS] treated with in vitro fertilization [IVF]. This prospective randomized controlled trial included a total of 80 women with PCOS. Of these, 38 were randomized to receive treatment with hMG and 42 with rFSH using a long gonadotropin releasing hormone [GnRH] analogue protocol. Outcome measures were cycle characteristics, pregnancy rates, the need for coasting, and OHSS rates. In the hMG group we observed a significantly lower peak estradiol [E2] level [p=0.02], fewer intermediate-sized follicles [p=0.001], lower number of oocytes retrieved [p=0.002] and metaphase II [MII] oocytes [p=0.003]. However, there were no significant differences between the groups in the number of fertilized oocytes, fertilization rates, top quality embryo counts, and the number of transferred embryos. There was no difference in pregnancy rates between the groups. OHSS occurred in 11.9% of the rFSH group patients, whereas no OHSS developed in the hMG group. Coasting requirements were lower in the hMG group [19.2% vs. 48.9%, p=0.013]. Ovarian stimulation with hMG and rFSH provides similar clinical pregnancy rates in PCOS patients treated with a long GnRH agonist protocol in IVF cycles. hMG stimulation appears to be associated with a lower rate of OHSS and decreased coasting requirements [Registration Number: NCT01365936]

Theuse of GnRH agonists in the treatment of endometriomas without drainage

To assess the efficacy of GnRH-agonist therapy in the treatment of endometriomas with or without surgical intervention, 26 women with laparoscopically proven endometriomas larger than 3 cm were recruited to the study. Fourteen women with 19 endometriomas [5 bilateral], had drainage of endometrioma at initial laparoscopy. After the procedure, ovarian suppression was done with GnRH-a therapy for 6 months. The second group which consisted of 12 women, had 17 endometriomas. No surgical procedure was performed. They received only GnRH-a therapy for 6 months. On repeat laparoscopy, in the first group, the rates of decrease in ovarian AFS scores of endometriomas and complete resolution were found as 100% and 37% respectively. In the second group the response was only 18% [p<0.0001]. It was concluded that drainage of the cyst [surgical therapy] combined with postoperative GnRH-a suppression is a better treatment modality than the use of GnRH-a [medical therapy] alone for endometriomas