R.W.S. Yates

Absence of effect of adjuvant growth hormone therapy on follicular responses to exogenous gonadotropins in women: normal and poor responders

Objective To examine the effects of growth hormone (GH) on ovarian responses to exogenous gonadotropins after pituitary desensitization in normal and poor responder patients undergoing in vitro fertilization. Design A prospective study with comparison of control and GH-treated cycles. Patients Poor responder patients (n=10) required >44 ampules of human menopausal gonadotropin (hMG) to achieve criteria for administration of human chorionic gonadotropin (hCG) on day 0 or cancellation in control cycles, and normal responder patients (n=10) required Main Outcome Measures Ovarian responses to hMG assessed by duration of stimulation required to achieve first significant estradiol (E 2 ) response and hCG criteria. Total doses and duration of hMG, follicular development and E 2 concentrations on day 0, and embryology were also assessed. Results Growth hormone showed no effect on any of the parameters studied in either patient group. Conclusion Follicular recruitment, E 2 secretion by mature follicles, and oocyte yield and quality were uninfluenced by GH treatment.

Luteinizing Hormone Increases Estradiol Secretion but has no Effect on Progesterone Concentrations in the Late Follicular Phase of In Vitro Fertilization Cycles in Women Treated with Gonadotropin-Releasing Hormone Agonist and Follicle-Stimulating Hormone

OBJECTIVE To determine whether the late follicular phase increase in circulating P concentrations during controlled ovarian stimulation with GnRH-a and FSH can be influenced by addition of LH to the stimulating gonadotropin during the final 2 days. DESIGN Randomization of patients to receive either FSH alone or FSH with LH (hMG) for the final 2 days before hCG, after follicular phase stimulation with purified FSH. SETTING A.C.S. Unit at the Royal Infirmary, Glasgow, U.K. PATIENT(S) Patients were unselected and were undergoing IVF. INTERVENTION(S) Patients received stimulation with purified FSH (300 IU/d) until a follicle of 15 mm was observed; the regimen was then changed to either 225 IU of FSH or 225 IU of hMG. MAIN OUTCOME MEASURE(S) Estradiol and P in the peripheral circulation. RESULT(S) Significant increases in E2 concentration were observed, but there were no changes in the circulating progesterone. CONCLUSION(S) The late follicular phase increase in P is unrelated to any luteinizing process attributable to effects in the circulation or sensitization of follicular cells to LH.

In vivo and in vitro maturation of human oocytes: effects on embryo development and polyspermic fertilization*** Supported in part by grant TA/GB/W75 from the White Top Foundation, Dundee, Scotland.

OBJECTIVE To compare the effects of in vivo and in vitro maturation of human oocytes. DESIGN Women (n = 60) undergoing follicular stimulation for in vitro fertilization, using long-course analog therapy to suppress endogenous luteinizing hormone (LH), were randomly allocated to a short (34 hour) or long (39 hour) delay between human chorionic gonadotropin (hCG) administration and oocyte retrieval. Each patients oocytes were divided into two groups that were either inseminated immediately or after 5 hours. RESULTS The incidence of polyspermic fertilization was highest in oocytes inseminated immediately after a short hCG/oocyte retrieval interval (17/100) and was significantly (P less than 0.05) reduced by preincubation and/or a long hGG/oocyte retrieval interval. Fertilization rates were higher with 39 hours than with 34 hours in vivo maturation (84.2% versus 76.8%; P less than 0.05). The incidence of delayed fertilization was reduced by extending the hCG/oocyte retrieval interval (short, 12.9%; long, 3.9%; P less than 0.001). CONCLUSIONS Extension of the in vivo maturation time increased fertilization rates and eliminated the requirement for preinsemination incubation, allowing simplification of laboratory procedures.