The patients who can benefit from this combination are those who usually need LH.
Photo: kindness
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Before starting an assisted fertilization treatment, specialists emphasize the importance of addressing the hormonal status of patients, a situation that is often unknown before the medical consultation.
A published study showed that, at the time of stimulating ovulation, the combination of two of the hormones of recombinant origin that intervene in the reproductive cycle in equal proportion to that produced naturally by the body increases the pregnancy rate in a specific group of women compared with other alternatives derived from products of urinary origin.
The two hormones are r-hFSH (recombinant human follicle-stimulating hormone) and r-LH (recombinant luteinizing hormone), a combination that decreases the time to get pregnant, since a smaller number of cycles are required to achieve it.
“In a young woman, her pituitary, which is what produces these hormones, does so in a ratio of 2 to 1 FSH/LH, so every time this combination is applied, the woman will be receiving 2 parts of FSH for 1 of LH, just like in nature and this is very beneficial for patients”, explained the specialist in Reproductive Medicine Marcos Horton.
In a dialogue with the press, the director of the Pregna Assisted Reproduction Laboratory and former president of the Argentine Society of Reproductive Medicine (SAMeR) added: “Currently, the exact combination of these hormones allows the dose to be adjusted individually and offers less possibility of patient error.
“The patient groups that benefit most from the combination are especially those women with severe FSH and LH deficiency, with low ovarian reserve, age over 35 years, or a history of poor response in previous cycles,” said the expert.
The patients who can benefit greatly from this combination are those who usually need LH, because if they receive only FSH, the appropriate conditions for the maturation and quality of the ovules will not be met in order to achieve a more suitable embryo.
FSH and LH deficiency can be congenital or acquired, permanent or transitory, and there are many factors that contribute to this situation that impacts the search for a pregnancy. The function of FSH is to regulate estrogen and control the reproductive process, while LH regulates the menstrual cycle, produces androgens and is responsible for triggering ovulation. The hormone LH, present during folliculogenesis -which is the process of follicle growth and its passage through the different stages of development-, acts in synergy with the hormone FSH to promote follicular development and maturation.
To determine the exact dose of the combination of both hormones of recombinant origin in fertility treatments in women with FSH and LH deficiency, two studies were carried out and both showed that the 2:1 ratio showed the optimal risk-benefit profile compared with the other proportions examined, whose relationship was very different (1 dose of FSH: 1.5 of LH; 1 of FSH: 1 of LH; 3 doses of FSH: 1 of LH; 6 doses of FSH: 1 of LH).
Currently there are ovarian stimulation strategies that provide the combination of both hormones in the exact proportion. “This could not be done before, the woman injected a little FSH and a little LH, there was no exact dose, the combination has the advantage that -despite the modification of the dose- the relationship is maintained, which it’s what the ovary needs to respond properly,” Horton said.
“Today, most of the products used are for the patient to do the application at home, they are a kind of pen with a very small needle,” said the specialist.
According to data from the Argentine Registry of Assisted Fertilization (RAFA) corresponding to 2019, some 15,555 fresh procedures were carried out in the country during that period (in the same cycle in which they were created), without the need to be frozen, with a rate of pregnancy that ranges between 16.23 and 34.05%, depending on the maternal age and whether the center is accredited or not.
Meanwhile, the pregnancy rate for transfer of frozen embryos in accredited centers was 32.2%. In turn, 4,060 egg donation records were made, of which 2,944 transfers resulted, through which 1,072 pregnancies were achieved. (NA)
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