Intrafollicular Endocrine Milieu Hormonal Profile Using Four Different Ovarian Stimulation Protocols: HMG, HMG/hCG, rFSH, rFSH/hCG: A Single-Center Pilot Study

Author(s): Papamentzelopoulou Myrto-Sotiria, Liokari Emanouela, Mavrogianni Despoina, Dimitroulia Evagelia, Stavros Sofoklis, Potiris Anastasios, Loutradis Dimitris

Objectives: The present single-center pilot study investigated for the first time the follicular fluid (FF) hormonal profile derived from four different ovulation induction protocols (HMG, HMG/hCG, rFSH, rFSH/hCG) in relation to the ovulation induction parameters, including number and quality of oocytes, and pregnancy rate. Methods: FFs were pooled for analyses for each one of the 94 patients that underwent a GnRH antagonist protocol with HMG, HMG/hCG, rFSH, or rFSH/hCG treatment. Intrafollicular hormone concentrations in relation to treatment groups, number and quality of oocytes, and pregnancy rate were measured. Results: Testosterone, FSH, androstenedione and estradiol levels were significantly higher in HMG/hCG-treated group (697±448 ng/ml, p=0.000, 8.75±2.82 IU/L, p=0.002, 6.90±2.77 ng/ml, p=0.000, and 38696391 ± 170049486 ng/ml, p=0.000, respectively). Progesterone and hCG levels were significantly lower in pregnant women treated with HMG compared to non-pregnant HMG-treated women (16184±3910 ng/ml vs 23338±8880 ng/ml, p=0.054 for progesterone, and 30.62±15.04 mIU/ml vs 63.00±25.61 mIU/ml, p=0.033 for hCG). Patients >34 years old that received HMG tended to have higher pregnancy rate (31.2%), while the rFSH-treated patients seemed to have a lower pregnancy rate (9.1%) (p=0.531). Conclusions: Ultimately, the present study demonstrates that the different gonadotropin preparations have an impact on the intrafollicular endocrine milieu hormonal profile. HMG/hCG-treated group presents the strongest androgenic environment, revealing that the treatment with HMG creates a strong androgenic environment that is in favor of successful reproductive outcome.