[Highly purified FSH for stimulation of down regulated cycles in the in vitro fertilization program]

Highly purified FSH (Fertinorm HP) was used for follicle stimulation during one cycle of IVF in each of 112 women. In all cases, stimulation was begun with 150 IU FSH per day s.c. after pituitary down-regulation with a GnRH analogue in a Long protocol. Sixteen (14.3%) of the 112 treatment cycles started were stopped before follicle aspiration. The reasons for stopping stimulation were elevated progesterone values with premature luteinisation in 9 (8.0%) patients, inadequate follicle stimulation in 4 (3.6%) cases and threatened overstimulation in 3 (2.7%) cases. The mean duration of stimulation was 11.8 days with 7.8 oocytes obtained per aspiration by the transvaginal rute. Embryo transfer was possible in 77 (68.7%) patients, with a mean of 2.3 embryos per transfer. A total of 23 clinical pregnancies resulted, with a pregnancy rate of 20.5% and 29.9% per cycle and embryo transfer, respectively. There were three cases of multiple pregnancy (13.0%), two (8.7%) miscarriages occurred and one patient (4.3%) had a tubal pregnancy. The rate of successful pregnancies was thus 17.9% per cycle. Five patients (5.2%) required treatment for overstimulation. There were not other treatment complications. These results show that highly purified FSH can also be used successfully in IVF after pituitary down-regulation. The remaining endogenous LH activity in these cases may be regarded as sufficient for follicular development and steroid synthesis. Highly purified FSH can therefore be used for all stimulation protocols in patients with normal gonadotrophin levels. The relatively low rate of miscarriages with this treatment is noteworthy.