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Does exogenous LH activity influence the outcome in IVF and not in ICSI cycles?

Does exogenous LH activity influence the outcome in IVF and not in ICSI cycles?. Peter Platteau, Johan Smitz, Carola Albano, Per Sørensen Joan-Carles Arce and Paul Devroey Center for Reproductive Medicine, AZ-VUB, Brussels, Belgium Ferring Pharmaceuticals A/S, Copenhagen, Denmark. EISG 2002.

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Does exogenous LH activity influence the outcome in IVF and not in ICSI cycles?

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  1. Does exogenous LH activity influence the outcome in IVF and not in ICSI cycles? Peter Platteau, Johan Smitz, Carola Albano, Per SørensenJoan-Carles Arce and Paul DevroeyCenter for Reproductive Medicine, AZ-VUB, Brussels, BelgiumFerring Pharmaceuticals A/S, Copenhagen, Denmark

  2. EISG 2002 GnRH agonist daily/depot HP-hMG or rFSH hCG Dose ↑↓ 32-42h 1 6 DAY 21 No Cyst E2<200pmol/L OPU ≥3 follicles ≥16mm and/or E2 ≥1000 pmol/L / foll ≥16mm European and Israeli Study GroupFertil Steril 2002

  3. EISG: Overall Results European and Israeli Study GroupFertil Steril 2002

  4. Cochrane Review 2002: RCTs hMG vs rFSH Clinical Pregnancy N hMG rFSH Long Protocol 1.26 (0.90-1.77) 727 EISG 2002 26% 22% Gordon 2001 38% 28% Ng 2001 25% 20% Westergaard 2001 40% 34% 31% 26% 1.55 (0.56-4.30) 68 1.32 (0.31-5.73) 40 1.26 (0.83-1.92) 379 1.28 (1.00-1-64) 0 1 2 3 4 5 6 Van Wely et al. 2002 Odds Ratio (95% C.I.)

  5. Cochrane Review 2002: RCTs hMG vs rFSH

  6. Pregnancy Rates IVF / ICSI

  7. Baseline Characteristics

  8. Follicle, Oocytes Retrieved, Fertilization Rate, Embryos Transferred: IVF / ICSI

  9. Distribution of Patients according to LH Levels IVF IU/L

  10. Ongoing Pregnancy Rates by hCG on Day 6 IVF ICSI IUl/L

  11. Hypothesis: LH Activity Effects via Cumulus Cells ICSI IVF

  12. Role of Cumulus Cells in Oocyte Viability and Early Development • Animal Studies • Mice, bovine and buffalo oocytes: removal of the cumulus before insemination is associated with reductions in cleavage rate, early embryo development and blastocyst formation • Human Studies • Protective effect of the cumulus on the oocyte against adverse environmental influences (Magier et al, 1990) • Preincubation with intact cumulus before ICSI improves fertilisation and cleavage rate (Hassan et al, 2001)

  13. Conclusions • A significantly higher ongoing pregnancy rate in IVF cycles was found in the HP-hMG group compared with rFSH • No difference was observed in ICSI cycles betweenthe HP-hMG and rFSH groups • In the HP-hMG group, higher midfollicular hCG levels were associated with ongoing pregnancy, especially in IVF cycles

  14. Future Directions • Prospective multicenter randomized controlled trial to confirm these findings • The role of cumulus cells in IVF cycles stimulated with different gonadotrophins

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