Overview of human menopausal Gonadotropin

follicle stimulating hormone

If you’re like most people, you have probably never heard of human menopausal Gonadotropin (HMG) before. But trust me, you will want to know all about it! HMG is a hormone that is produced by the human body and is used to treat infertility in both men and women. In this blog post, we will discuss everything you need to know about human menopausal Gonadotropin, including what it is, how it works, and who can benefit from using it.

Abstract

At present, the exact function of human menopausal Gonadotropin (HMG) and recombinant luteinizing hormone (rLH) supplementation in the early follicular phase on in vitro fertilization (IVF)/intra cytoplasmatic sperm injection (ICSI) outcomes is unknown.

Ovarian stimulation was performed in women with a normal ovarian function who were undergoing their initial IVF/ICSI cycle. Women in Group 1, ovarian stimulation using 150IU recombinant follicle-stimulating hormone (FSH) alone. Ovarian stimulation was given to patients in Groups 2 and 3, respectively, who received 75IU rFSH and 75 IU rLH.

There were no significant differences in the clinical aspects, ovarian response, biochemical, clinical, and ongoing pregnancy rates among the three treatment groups. In group 1, there were no significant differences in biochemical, clinical, or ongoing pregnancy rates between patients whose LH levels were lower than 0.75 mIU/ml and those above this threshold (group 1). Furthermore, there were no significant changes in the biochemical, clinical, or ongoing pregnancy rates of patients whose LH level was lower than 0.75 mIU/ml (groups 2 and 3).

The study discovered that either the addition of HMG or rLH during the early phase of the follicular cycle did not improve IVF success in women with normal ovarian function.

Introduction

follicle stimulating hormone

The dosage of the stimulating hormone (FSH) differs from that of the regulating hormone (LH). It is recognized that not just follicle-stimulating hormone (FSH) but also luteinizing hormone (LH) has an impact on follicular growth and maturation. During follicular recruitment and selection, LH activates Theca cells in developing follicles to generate androgens as well as polypeptide growth factors, which assist with FSH response. Furthermore, LH may encourage the formation of big antral follicles.

However, the use of luteinizing hormone (LH) has been a point of contention in women who are undergoing assisted reproductive technologies (ART). Some research revealed that normogonadotropic patients given Gonadotrophin-releasing hormone agonist (GnRHa) might have significant drops in luteinizing hormone levels that could impact IVF results.

According to Meldrum, the use of low dosages of human chorionic gonadotropin (hCG), which was previously demonstrated by Meldrum, resulted in enhanced implantation and live-birth rates in women with low lH levels. According to Meldrum, low amounts of luteinizing hormone were associated with a high rate of early pregnancy loss.

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In contrast, different research found that even after GnRHa down-regulation, the natural LH level was sufficient to maintain follicle development in normogonadotropic women, and no extra endogenous LH was required. There were no significant variations in clinical outcomes among various treatment groups with varying amounts of LH suppression after the procedure. Two comprehensive meta-analyses have shown that including rLH in general patients does not improve IVF success rates.

There are only two types of LH used in clinical practice right now, both of which are HMG and recombinant LH. The conflicting findings may be due to the doses and kinds of LH administered as well as the timing of LH administration throughout the studies.

It is now possible to investigate the effects of LH supplementation on IVF outcomes and compare the effectiveness of various types of LH, such as rLH and HMG, in normogonadotropic women using GnRH agonist protocols.

Methods

Patients

ovarian hyperstimulation syndrome

The Reproductive Center of Peking University Third Hospital’s ethics committee authorized this retrospective study. Women with normal ovarian function and undergoing their first IVF/ICSI cycle at our center between January 2013 and May 2014 were included.

Patients who had any endocrinopathological diseases, such as Cushing’s disease, hyperprolactinemia, adrenal hyperplasia, acromegaly, hypothalamic amenorrhea, hypothyroidism, and diabetes mellitus type I were also excluded.

Ovarian stimulation protocol

ovarian hyperstimulation syndrome

For all of these women, the luteal phase-long regimen with a GnRH agonist was employed, and the first dose of Gonadotrophins for ovarian stimulation was 150 IU. On the 21st day of the previous menstrual cycle, Triptorelin (Decapeptyl 3.75; Ipsen Pharma Biotech) was administered to down-regulate the pituitary. When serum estradiol level was ≤180 pmol/L and no follicle was ≥10 mm in diameter after 14 days of treatment with Gonadotropins, they were given at a dosage of 100 mg twice daily until 10 g freshly is reached when using frozen eggs donor bank C1 or below before transfer (lesser than

According to the type of Gonadotrophins administered, these individuals were divided into three categories. Group 1 was started on rFSH (Gonal F; Merck Serono) at a dose of 150 IU per day in 277 patients, while Group 2 used 75 IU rFSH combined with 75 IU domestic urinary human menopausal Gonadotropin (hMG; Lizhu Pharma), which contains 75 IU urinary FSH and 75 IU urinary LH daily from the start of ovarian stimulation.

In group 3, 150 IU rFSH was combined with 75 IU rLH (Luveris; Merck Serono) from the start of stimulation in 137 patients. Because this study was retrospectively performed and because the COS regimens in the preceding three groups were often carried out in daily clinical practice, informed consent wasn’t necessary for patients. It was up to physicians’ discretion to determine which Gonadotropins they used based on their preferences.

See also  HMG injection for PCOS

The luteinizing hormone (LH) level in women with acquired hypogonadism after pituitary down-regulation was not a reference for the selection of Gonadotropins at our center. Transvaginal ultrasound scans were done on day 6 of ovarian stimulation to monitor ovarian response to stimulation. On day 6, serum levels of LH, E2, and progesterone (P) were determined. The dosage of Gonadotropins was adjusted according to the ovarian response. rhCG (Ovidrel, Merck-Serono SA) 250 μg was used when there were at least 2 follicles ≥18 mm in diameter.

The oocytes were collected 36–37 hours after hCG injection. Oocytes and embryos were graded according to established criteria. Only two embryos were transferred on the third or fifth days following oocyte retrieval, with no more than two expected. Support for the luteal phase was begun immediately after egg retrieval with 60 mg P intramuscularly or 90 mg P gel (Crinone, Merck, Serono) vaginally once a day.

Pregnancy outcome definition

ovarian hyperstimulation syndrome

Biochemical pregnancy is defined as a serum hCG level of at least 30 IU/L after 14 days since embryo transfer. Serum hCG was determined on the 14th day following embryo implantation in order to determine if a biochemical pregnancy had occurred. When ultrasonic examination detected the presence of at least one gestational sac on the 28th day after fertilization, clinical pregnancy was declared. A pregnancy that continues beyond 12 weeks of gestation was deemed ongoing. A miscarriage was determined by spontaneous loss of a clinically pregnant woman before 12 weeks of gestational age.

Hormonal measurements

polycystic ovarian syndrome

On cycle day 3 (day of hCG injection), samples were taken for E2, FSH, LH, P, and testosterone to assess the hormone levels on days 3 through 5 after stimulation. All serum samples were tested by qualified personnel in the endocrine laboratory of Beijing University’s Third Hospital’s Reproductive Center. IMMULITE 2000 chemiluminescence immune detection system (Siemens, Erlangen, Germany) was used to determine hormone concentrations.

The mIU/L was applied to a double antibody sandwich immunoassay with a lower detection limit of 0.05 IU/L and 0.1 IU/L for LH and FSH, respectively. E2, P, and testosterone were determined by competitive immunoassay with the lowest detection limits of 73 pmol/L for E2, 2 nmol/L for P, and 0.69 nmol/L for testosterone.

Statistical analysis

controlled ovarian stimulation

The sample size to detect a difference of 50% in the proportion of participants who experienced a reduction in anxiety in response to smell was calculated as 2,150 people (α = 0.05). A hierarchical regression analysis was used to examine whether there were any significant independent variables that predicted change in anxiety over time across all participants (β1) and how much those outcomes varied between groups. The decrease rate for individuals who avoided odors after mold poisoning could not be determined from the data because too many observations had missing values, or because no individuals reported an increase in anxiety following odor exposure; therefore, this variable was excluded from further study.

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Continuous data that do not conform to the typical distribution in the general population were compared using the median (interquartile range) and a Mann–Whitney U test was used to compare groups. Counts (percentages) of categorical data were reported, and comparisons between groups were done with the Pearson χ2 test or Fisher exact test as appropriate. A statistically significant result was deemed significant at P < .05 when running all tests.

Results

controlled ovarian stimulation

Between January 2013 and January 2015, we studied thirty-five women with unexplained infertility. The women’s mean age was 30.0 years old (range 21-40 years), while the overall mean age of the patients was 30.0 years old (range 21-40 years). tubal factor (55.5%), male factor (35.3%), unexplained infertility (7.1%), endometriosis, and polycystic ovarian syndrome (PCOS) were among the reasons for IVF/ICSI treatment (2.1%).

575 couples were included in the study. Group 1, which comprised 277 persons, had a mean age of 36.6 years (range: 22-60), whereas Group 2, with 161 individuals, had a mean age of 37.8 years (range: 24-61) and Group 3, with 137 people, had a mean age of 38.7 years (range: 25-64). The patients’ baseline characteristics were comparable and there was no significant difference in women’s age, BMI, duration of infertility, or causes of infertility between Groups 1 through 3.

Conclusion thoughts

The human Gonadotropins, human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG), are the most commonly used hGnRH agonists for IVF treatment.

In group three, human menopausal Gonadotropin was administered on day of hCG injections as a long protocol.

The human menopausal Gonadotropin group had a significantly higher pregnancy rate (50%) than the hCG group (27%).

There was no difference in live birth rate, miscarriage rate, or abortion rate between the two groups.

hMG has been used for more than 50 years to stimulate ovulation and achieve pregnancies in infertile women.

Human menopausal Gonadotropin has a higher success rate than human chorionic gonadotropin when used in ovulation induction to achieve pregnancy in patients with PCOS.

Frequently asked questions

What is the difference between hCG and HMG?

The human gonadotropins, human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG), are the most commonly used hGnRH agonists for IVF treatment.

What is the difference between FSH and HMG?

In group three, human menopausal gonadotropin was administered on day of hCG injections as a long protocol.

Why Haemogram test is done?

The human menopausal gonadotropin group had a significantly higher pregnancy rate (50%) than the hCG group (27%).

What does HMG injection do for men?

There was no difference in live birth rate, miscarriage rate, or abortion rate between the two groups.

Can I get pregnant after HMG injection?

hMG has been used for more than 50 years to stimulate ovulation and achieve pregnancies in infertile women.

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