Rapid Health Technology Assessment of Recombinant FSH versus Urine FSH in Ovulation Induction Therapy for in vitro Fertilization/intracytoplasmic Sperm Injection -embryo Transfer / 中国药房

OBJECTIVE：To compare th e efficacy ，safety and economics of recombinant human follicle stimulating hormone （rFSH）and urin follicle stimulating hormone （uFSH）in the ovulation induction therapy for in vitro fertilization/intracytoplasmic sperm injection-embryo transfer ，and to provide evidence-based evidence for rational use of rFSH in the clinic. METHODS ： Retrieved from PubMed ，Embase，the Cochrane Library ，CNKI，VIP，Wanfang database as well as professional health technology assessment（HTA）database，HTA，systematic review/Meta-analysis and economic studies were collected to compare the effects of rFSH versus urine FSH （uFSH）in ovulation induction for in vitro fertilization/intracytoplasmic sperm injectionembryo transfer （IVF/ICSI-ET）. After literature screening ，data extiaction and quality evaluation ，the conclusions of the included studies were summarized by using qualitative description. RESULTS ：A total of 7 literatures were included ，involving 2 systematic reviews/ Meta-analysis and 5 economic evaluations ，and no HTA report was retrieved. All the studies were reported from abroad. Systematic evaluation/Meta-analysis showed that the number of oocytes obtained in the rFSH group was higher than that in the uFSH group. There was no statistical significance in persistent pregnancy rate ，clinical pregnancy rate ，live birth rate ，abortion rate and the incidence of ovarian hyperstimulation syndrome （OHSS）between 2 groups（P＞0.05）. Economic research showed that rFSH may have cost-effective advantage. CONCLUSIONS ：Current available evidence support that rFSH has simialr efficacy and safety for ovulation induction of IVF/ICSI-ET ，and shows cost-effec- tiveness advantage.

Effectiveness of Gonadotropin-Releasing Hormone Antagonists in the Management of Multifollicular Recruitment in Intrauterine Insemination Cycles.

Introduction: To evaluate the efficacy of GnRH antagonists in terms of increasing the pregnancy rates in intrauterine insemination (IUI) after controlled ovarian stimulation (COS) when more than one dominant follicle is recruited. Methods: This is a prospective and randomized clinical trial that included 300 couples with primary or secondary infertility that underwent their first or second COS-IUI cycle with recombinant FSH. In all of these patients two or three leading follicles > 14 mm of mean diameter where detected by vaginal ultrasound (US) and were randomized into two groups. In group A the patients received rFSH+GnRH antagonists until the day that the hCG was given, while in group B the patients followed a standard COS received rFSH only. Results: Total amount of rFSH units (620.8+245.1vs 575.5+296.4) and clinical pregnancy rates (31.16% vs 19.15%) were statistically significantly higher in patients who were treated with GnRH antagonists. A similar number of twin pregnancies and miscarriages occurred in both groups. Conclusion: Multiple doses of GnRH antagonists in COS-IUI significantly increase pregnancy rates in multifollicular cycles.

Comparison of Clinical Efficacy between a Single Administration of Long-Acting Gonadotrophin-Releasing Hormone Agonist (GnRHa) and Daily Administrations of Short-Acting GnRHa in In Vitro Fertilization-Embryo Transfer Cycles

This study was aimed to evaluate the efficacy of a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) as compared with daily administrations of short-acting GnRHa in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) cycles. The mean dosage of recombinant follicle-stimulating hormone (rFSH) required for COH (2,354.5+/-244.2 vs. 2,012.5+/-626.1 IU) and the rFSH dosage per retrieved oocyte (336.7+/-230.4 vs. 292.1+/-540.4 IU) were significantly higher in the long-acting GnRHa group (N= 22) than those in the short-acting GnRHa group (N=28) (p<0.05). However, the mean number of visit to the hospital that was required before ovum pick-up (3.3+/-0.5 vs. 22.2+/-2.0) and the frequency of injecting GnRHa and rFSH (12.8+/-1.2 vs. 33.5+/- 3.5) were significantly decreased in the long-acting GnRHa group (p<0.0001). The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different between the 2 groups. So, we suggest that a single administration of long-acting GnRHa is a useful alternative for improving patient's convenience with clinical outcomes comparable to daily administrations of short-acting GnRHa in COH for IVF-ET cycles.

Alteration of Gene Expressions in Human Endometrial Stromal Cells by Exogeneous FSH Treatments / 대한불임학회지

OBJECTIVE: To evaluate the effects of recombinant FSH (rFSH) and urinary FSH (uFSH) on the gene expressions of human endometrial stromal cells in vitro. METHODS: Endometrial tissue was obtained from a pre-menopausal women undergoing hysterectomy. Primary endometrial stromal cells were isolated and in vitro cultured with FBS-free DMEM/F-12 containing 0, 10, 100, and 1,000 mIU/ml of rFSH and uFSH for 48 hours, respectively. Total RNA was extracted from the cultured cells and subjected to real time RT-PCR for the quantitative analysis of progesterone receptor (PR), estrogen receptor alpha/beta (ER-alpha/beta), cyclooxygenase 2 (Cox-2), leukemia inhibitory factor (LIF), homeobox A10-1 and -2 (HoxA10-1/-2). RESULTS: Both hormone treatments slightly increased (< 3 folds) the expressions of PR, ER-beta and HoxA10-1/-2 gene. However, ER-alpha expression was increased up to five folds by treatments of both FSH for 48 hours. The LIF expression by the 10 mIU/ml of uFSH for 12 hours was significantly higher than that of rFSH (p<0.01). After 24 hours treatment of two kinds of hormones, the expression patterns of LIF were similar. The 100 and 1,000 mIU/ml of rFSH induced significantly higher amount of Cox-2 expression than those of uFSH, respectively (p<0.05). CONCLUSION: This study represents no adversely effect of exogeneous gonadotropins, rFSH and uFSH, on the expression of implantation related genes. We suggest that rFSH is applicable for the assisted reproductive technology without any concern on the endometrial receptivity.