Oestradiol and immunoreactive inhibin-like secretory patterns following controlled ovarian hyperstimulation with urinary (Metrodin) or recombinant follicle stimulating hormone (Puregon)

• Published in: Human reproduction (Oxford) 1996-05, Vol.11 (5), p.962-967
• Main Authors: Mitchell, R., Buckler, H.M., Matson, P., Lieberman, B., Burger, H.C., Hilton, B., Horne, G., Dyson, M., Robertson, W.R.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Birth control; Chorionic Gonadotropin - therapeutic use; Estradiol - metabolism; Female; Follicle Stimulating Hormone - blood; Follicle Stimulating Hormone - therapeutic use; FSH; Gynecology. Andrology. Obstetrics; Humans; Infertility, Female - therapy; inhibin; Inhibins - metabolism; IVF; Luteinizing Hormone - blood; Medical sciences; Ovarian Follicle - physiology; Ovary - diagnostic imaging; Ovulation Induction; recombinant proteins; Recombinant Proteins - therapeutic use; Sterility. Assisted procreation; Ultrasonography
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/oxfordjournals.humrep.a019332

Inhibin (and its a-subunit) may be of particular value as a marker for follicular development in in-vitro fertilization (IVF) in comparison with the classic follicle stimulating hormone (FSH)-dependent marker oestradiol in patients following pituitary desensitization and treatment with recombinant FSH (rFSH). This preparation lacks lutein-izing hormone (LH), which is essential for thecal cell androgen secretion and thus oestradiol production. Our study has assessed oestradiol and immunoreactive inhibin-like secretion following ovarian stimulation with rFSH or a purified urinary FSH preparation (Metrodin) (uFSH). A randomized, assessor-blind study was initiated using patients receiving a single treatment cycle of IVF (using fresh embryos) following pituitary desensitization with intranasal buserelin (500 g daily) and the i.m. injection of either rFSH (n = 38) or uFSH (n = 17). Ovarian ultrasound examinations were performed and bloods (10 ml) collected prior to FSH treatment and every 1–2 days until ovulation induction with human chorionic gonadotrophin. LH and FSH concentrations were measured by an immunoradiometric assay, and inhibin-like immuno-reactivity by a radioimmunoassay and an enzyme-linked immunosorbent assay, both with α-subunit specificity. Oestradiol concentration was measured with a coated tube radioimmunoassay. Following desensitization, basal LH, FSH and oestradiol concentrations were measured, as was that of immunoreactive inhibin. Following treatment with either rFSH or uFSH, LH concentrations remained low while FSH concentrations rose to a plateau of 5.6–6.7 IU/1 in both groups. In contrast, the concentration of oestradiol was higher (P ≤ 0.05) with rFSH than with uFSH in the last four days of treatment, a pattern that was repeated for inhibin-like immunoreactivity. The change in oestradiol and inhibin concentrations during treatment was -2-fold higher with rFSH. The total number of follicles obtained with rFSH was similar to that with uFSH. However, the number of follicles with a diameter of 5*15 mm was higher in the rFSH group, and there was a concomitant increase in the number of oocytes recovered. Oestradiol concentration and inhibin-like immunoreactivity (determined by either method) were associated with total follicle number and number of follicles ≥15 mm in diameter, as well as with each other (P < 0.001). When ovarian hormone output was normalized per follicle produced, oestradiol output was higher for rFSH than for uFSH (P = 0.04