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대한생식의학회지 제24권 제1호 2010년
체외수정시술을 위한 과배란유도시 Highly Purified Follicle Stimulating Hormone (HP-FSH) 피하주사와 Follicle Stimulating Hormone 근육주사의 비교연구
연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;연세대학교 의과대학 산부인과학교실;
배상욱;김진영;원종건;정창진;장경환;이병석;박기현;조동제;송찬호;,
Subcutaneous Administration of Highly Purified-FSH(HP-FSH) versus Intramuscular Administration of FSH in Superovulation for IVF-ET
Bai, S.W.;Kim, J.Y.;Won, J.G.;Jung, C.J.;Chang, K.H.;Lee, B.S.;Park, K.H.;Cho, D.J.;Song, C.H.;
Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;Department of Obstetrics and Gynecology, College of Medicine, Yonsei University;
The early studies demonstrated that the relative amount of FSH was important for stimulating normal ovarian activity and demonstrated the existence of a threshold level for FSH, above which follicular growth was activated. It was found that only a modest increase in circulating FSH level above the threshold (between 10 and 30%) was required to stimulate folliculogenesis. In addition, FSH is primary responsible for initiating estradiol production through the activation of the aromatase enzyme system in granulosa cells, follicular secretion and growth. LH on the other hand, plays a supportive role in ovarian steroidogenesis, stimulating the ovarian thecal cells to produce androgen, the precursor for estradiol synthesis. But there is now an increasing number of reports in the literature demonstrating an adverse effect of LH on fertility and miscarriage in infertile and fertile women. So HP-FSH is the drug of a highly purified FSH preparation which has a higher specific activity and far fewer impurities than FSH. This study was performed to evaluate the efficacy and safety of HP-FSH administered (SC; subcutaneous) versus FSH(IM; intramuscular) for ovulation induction. 20 candidates patients for ovulation induction were participated. All patients underwent pituitary desensitizing with a long gonadotropin-releasing hormone (GnRH) agonist protocol and ovulation induction was started with HP-FSH SC (10 patients; group I) or FSH IM (10 patients; group II). After ovulation, outcome of ovulation induction and local reaction of injection site were compared. There were no difference of outcome of ovulation in two groups except pregnancy rate/embryo transfer. Group I had a higher pregnancy rate/ embryo transfer than Group II (44.4% Vs 28.6%). Pain, redness, tenderness, bruising and itching when the injection received on the first 5 days of treated (50 SC and 50 IM injections) were assessed. There were no significant difference (P>0.05) in the incidence of tenderness, bruising and itching between the IM and SC injection. But IM injection (FSH) had a tendency of higher above incidence. The number of reports of pain, redness were significantly increased in IM injection group (P<0.05). These results indicate that SC administration of HP-FSH has been shown to be as effect for superovulation as traditional gonadotropins, with an improved safety profile due to the removal of extaneous proteins.
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