Spermatogenesis of combined HCG and HMG in patients with idiopathic hypogonadotropic hypogonadism and congenital combined pituitary hormone deficiency / 中华内分泌代谢杂志

Objective:To compare the spermatogenes response of human chorionic gonadotropin(HCG)combined with human menopausal gonadotropin(HMG)in patients with idiopathic hypogonadotropic hypogonadism(IHH)and congenital combined pituitary hormone deficiency(CCPHD), and to explore related factors.Methods:Clinical data of 90 IHH patients and 61 CCPHD patients from January, 2014 to November, 2018 were retrospectively analyzed. Spermatogenesis was compared between the two groups receiving combined gonadotropin therapy. The patients were then divided into two subgroups: spermatogenesis subgroup and nonspermatogenesis subgroup. Related factors of spermatogenesis after the combined gonadotropin therapy were investigated.Results:After the combined treatment of HCG/HMG for 3, 6, and 9 months, the patients with CCPHD revealed lower testicular sizes than those with IHH( P=0.004, 0.021 and 0.032, respectively). Compared with IHH patients, CCPHD patients had larger testicular volume increments( P<0.001), higher spermatogenesis rates( P=0.048), and shorter initial time for sperm appearance( P<0.001)after 24-month treatment. Multivariate logistic regression analysis showed that lower total cholesterol(TC)(IHH group: OR=5.508, 95% CI 1.110-27.326, P=0.037; CCPHD group: OR=4.068, 95% CI 1.077-15.371, P=0.039)was an independent risk factor of poorer spermatogenesis in patients with IHH and CCPHD. Conclusions:The patients with CCPHD demonstrate a better response to combined gonadotropin treatment than those with IHH. Lower TC is an independent risk factor for poor spermatogenesis of combined HCG/HMG therapy in patients with IHH or CCPHD.

Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination

Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI. Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles). Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05. Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.

Influence of high-purity human menopausal gonadotropin added in process of antagonist program COH in IVF-ET pregnancy outcome in patients with normal ovarian function reserve / 吉林大学学报(医学版)

Objective; To investigate the influence of high-purity human menopausal gonadotrophin (HP-hMG) added in different periods of antagonist program COH in the pregnancy outcom of in vitro fertilization-embryo transplantation (IVF-ET) of the patients with normal ovarian function reserve, and to clarify the possible mechanism. Methods; A totol of 142 patients aged from 25 to 40 years old with normal ovarian function underwent IVF treatment were selected. According to the timing of HP-hMG addition, they were divided into early addition group (HP-hMG was added on the first day) and middel and latel addition group (HP-hMG was added on the 6th day). The pregnancy outcomes of the patients were analyzed. Results; Compared with early addition group, the estradiol (E2) level on the day of human chorimic gonadotropin (HCG) injection in middle and late addition group was significantly increased (P = 0.042) and the progesterone (P) level on the day of HCG injection was significantly decreased (P=0. 016), the number of follicles with diameter> 16 mm (P=0. 035) and the number of follicles with diameter >18 mm (P= 0. 026) were increased. Compared with early addition group, the rate of mature follicles in middle and late addition group was increased (P=0. 006), the rate of high quality embroy was increased (P=0. 001), and the cumulative pregnancy rate was increased (P=0. 040). Conclusion: The addition of HP-hMG at middle and late follicular phase can improve the pregnancy outcome in the patients with normal ovarition function reserve under went antagonist program COH.

Effects of HMG supplementation in the middle and late follicle phases on the outcome of in vitro fertilization-embryo transfer / 重庆医学

Objective To explore the effects of human menopausal gonadotropopin(HMG) supplementation on the outcome of women underwent in vitro fertilization-embryo transfer(IVF-ET) .Methods The data of 406 IVF-ET cycles in Reproductive Medi-cine Center of the 105th Hospital of PLA were analyzed retrospectively .All cases underwent long down regulation protocol with gonadotropin releasing hormone agonist(GnRH-a) in the mid-luteal phase and controlled ovarian stimulation(COS) was carried out with follicle stimulation hormone(r-FSH) on the days 3 -5 of the menstrual cycle .Then 75 -150 U HMG was administrated in group A(257 cycles) when a dominant follicle reached a diameter of 14 mm ,while the remaining cases(149 cycles) underwent HCG still with r-FSH were served as group B .Based on the LH levels on the day of HMG administration ,the cases in group A were sub-divided into :group A1(99 cycles) ,LH2 U/L .Clinical outcomes of all groups were analyzed and compared .Results The durations and doses of gonadotropin(Gn) ,the rates of fertilization and pregnancy were higher and the abortion rate was lower in group A than that in group B (P0 .05) .There was significant difference in serum LH levels on the day of HMG supplementation among group A1 ,A2 and A3(P0 .05) .Conclusion HMG supplementation in the middle and late follicle phases in stand-ard long down-regulation protocol during IVF could obtain higher pregnancy rate and lower abortion rate ,especially when their ser-um LH level was between 1 U/L and 2 U/L without obvious increase of LH .

Therapy with Human Chorionic Gonadotropin and Human Menopausal Gonadotropin in Men with Hypogonadotropic Hypogonadism / 대한남성과학회지

PURPOSE: Hypogonadotropic hypogonadism (HH) is an uncommon cause of virilization and male infertility. We evaluated the effect of the combination therapy with human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) in patients with HH. MATERIALS AND METHODS: Between May 2000 and April 2007, we evaluated 15patients with HH. Testicular volume, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, and semen analysis were consecutively monitored at 6, 12, 24, 36 and 48 months after hCG/hMG combination therapy. Statistical analysis was performed by Paired Student's t-test. RESULTS: Testicular volume showed a time-dependent increase in all patients who received hCG/hMG combination therapy (p<0.01). At 12 months, 12 patients showed and were significant improvement in FSH (1.6+/-0.97mIU/ml, p<0.033) and in serum total testosterone (71+/-2.73ng/ml, p=0.003), respectively. During hCG/hMG combination therapy, semen volume, sperm number, sperm motility, and sperm morphology were improved. However, there was no significant change in LH levels. CONCLUSIONS: Our experience in the management of the patients with HH suggests that hCG/hMG combination therapy might be effective in improving the sperm volume, sperm number, sperm motility, sperm morphology, plasma FSH, total testosterone level, and testicular volume. Thus hCG/hMG therapy seems a better choice in the patients with HH who want pregnancy.

Chronic tubal pregnancy diagnosed at cesarean delivery in infertile woman conceived after ovulation induction by clomiphene citrate and human menopausal gonadotropin / 대한산부인과학회지

Preoperative diagnosis of heterotopic pregnancy is difficult, especially when ectopic component is chronic and the precise effect of chronic tubal pregnancy on coexisting intra-uterine pregnancy or ongoing pregnancy rates is not known. We present the case of heterotopic pregnancy with a chronic tubal pregnancy incidentally diagnosed during term cesarean delivery in infertile woman conceived after ovulation induction using sequential clomiphene citrate and human menopausal gonadotropin, and timed coitus. Chronic tubal pregnancy might not affect the intrauterine gestation or the mother negatively in non-ruptured cases.

Chronic tubal pregnancy diagnosed at cesarean delivery in infertile woman conceived after ovulation induction by clomiphene citrate and human menopausal gonadotropin / 대한산부인과학회지

Preoperative diagnosis of heterotopic pregnancy is difficult, especially when ectopic component is chronic and the precise effect of chronic tubal pregnancy on coexisting intra-uterine pregnancy or ongoing pregnancy rates is not known. We present the case of heterotopic pregnancy with a chronic tubal pregnancy incidentally diagnosed during term cesarean delivery in infertile woman conceived after ovulation induction using sequential clomiphene citrate and human menopausal gonadotropin, and timed coitus. Chronic tubal pregnancy might not affect the intrauterine gestation or the mother negatively in non-ruptured cases.

Randomized Controlled Trial of Follicle-Stimulating Hormone Versus Human Menopausal Gonadotropin in Controlled Ovarian Hyperstimulation for in Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

Recent evidence suggests that a high level of serum LH during follicular recruitment and development is associated with poor reproductive outcome. Consequently, exogenous LH administration for controlled ovarian hyperstimulation(COH) in in vitro fertilization and embryo transfer(IVF-ET) may be harmful to folliculogenesis. The purpose of this clinical study was to evaluate and compare the efficacy of human menopausal gonadotropin(hMG) and human follicle-stimulating hormone(hFSH) for COH with long protocol of gonadotropin-releasing hormone(GnRH) agonist in IVF-ET program. Randomized clinical trial was performed in 125 patiens undergoing IVF-ET at Seoul National University Hospital from May to Septebmer, 1995. The inclusion criteria of patients included age < 40 years and normal semen analysis, and the study population was also classified into two groups by the etiology of infertility : Group T - 95 patients with only tubal factor and Group O - 30 patients with endometriosis or anovulatory factor. There were no statistically significant differences in dosage(29.0+/-7.9 vs 26.0+/-6.8 ampoules) and duration(12.3+/-1.3 vs 12.2+/-1.5 days) of gonadotropin administration, serum E2 level on hCG day(1,943+/-1,255 vs 1,580+/-1,067 pg/mL), cancellation rate(7.5% vs 6.7%), number of oocytes retrieved(9.9+/-6.0 vs 11.3+/-6.0), fertilization rate(68.4% vs 64.5%), number of embryos transferred(4.7+/-2.0 vs 4.7+/-2.0), and preganancy rate per cycle(26.3% vs 24.4%) and per ET(28.4% vs 26.2%) between hMG(N=80) and hFSH(N=45) Groups. In Group T, no significant differnces in results of IVF-ET were also detected between hMG (N=61) and hFSH(N=34) Groups. In Group O, serum E2 level on hCG day was significantly higher in hMG Group (N=19) compared with hFSH Group(N=11), but other results of IVF-ET were similar in both Groups. As this study could not demonstrate any significant differences in results of IVF-ET between hMG and hFSH when used for COH in IVF-ET program, it could be concluded that hFSH is at least as efficacious as hMG for COH.

HUMAN GAMETE INTRA-FALLOPIAN TRANSFER / 解剖学报

6 cases of gamete intra-fallopian transfer (GIFT) were performed in cooperation with the Department of Gynaecology and Obstetrics of The Third Teaching Hospital of our university in 1987. All the six women aged less than 41 years and have failed to be pregnant as long as ten years. One fallopian tube is patent at least. Two of them were pregnant after operation of GIFT. The rate of success was 33％. We used Ham's F10 medium mixed with different concentrations of fetal cord serum or mother's serum to prepare respectively follicular flushing medium (FM), sperm washing medium (SW), growth medium (GM) and transfer medium (TM). Clomiphene citrate and human menopausal gonadotropin (HMG) were used for inducing growth of follicle. HCG was given by intramuscular injection when two or more follicles were measured 16 mm in diameter by pelvic ultrasound. 32-34 hours later, follicular aspiration were performed by abdominal operation and the oocytecorona-cumulus complexes (OCCCs) were collected and trimmed under stereo microscope. The semen samples were obtained by means of masturbation 2-3 hours before operation. After centrifuged twice, the liquified semen was mixed with SW and incubated with 5％ CO_2 in air at 37℃ until GIFT.The OCCCs and 25?l processed semen were loaded into a special catheter and transferred into one fallopian tube. Then the transfer procedure was repeated for the other fallopian tube. The level of HCG in blood was examined from day 11 after transfer in order to diagnose pregnancy.