Miscellaneous

Question 1

3 formulations of gonadotropins available

Answer 1

• Urinary extracts
• Purified urinary extracts
• Recombinant synthetic

Question 2

human menopausal gonadotropin (hMG)

Answer 2

• 1st gonadotropin developed for clinical use “menotropins”
• Extracted from urine of post-menopausal women
• Contains FSH, LH, and now hCG
• 75 units of FSH and LH

Question 3

2 types of FSH available for IVF stimulation

Answer 3

1. Urinary purified - IM or SQ, some urinary contaminants
2. Recombinant (Follitropin alpha or beta)- SQ (using Chinese hamsters), increased production/reliability of product

Question 4

____ in IVF may induce luteal phase deficiency

Answer 4

High dose GnRH agonists

Therefore, luteal phase support is necessary for most COS in IVF

Question 5

Options for luteal phase support in COS?

Answer 5

• IM or PV progesterone (PO progesterone effectiveness unclear)
  (PIO 50 mg QD IM, micronized PV 600 mg QD, 8% 90 mg progesterone vaginal gel QD, micronized natural PV 300 mg QD)
  *IM may be better? Meta-analysis
• hCG 1 week after trigger (250 mcg SQ recombinant hCG vs 2,500-5,000 IU hCG IM) –> stimulates ovaries to produce progesterone support

Both are effective in providing luteal support, but hCG assoc with higher OHSS risk