Recombinant follitropin alfa/lutropin alfa in fertility treatment

Abstract

Recombinant human follicle stimulating hormone (rFSH) and luteinizing hormone (LH), also known as follitropin alpha and lutropin alpha, are manufactured by genetic engineering techniques which ensure high quality and batch to batch consistency. Follitropin alpha can be used for controlled ovarian hyperstimulation in assisted reproduction, ovulation induction for WHO group I and II anovulatory infertility and in men with hypogonadotrophic hypogonadism (HH) or idiopathic oligo-asthenospermia. Current evidence suggests superiority of urinary human menopausal gonadotropin (HMG) over follitropin alpha in controlled ovarian hyperstimulation for IVF in terms of live birth rate per couple. Addition of lutropin to follitropin alpha in an unselected IVF population does not appear to confer any benefit; however, it may have a role in ovulation induction in women with hypothalamic hypogonadism. Urinary HMG preparations (especially currently available highly purified preparations) are more cost effective than rFSH in terms of cost per ongoing pregnancy. However, women using rFSH injection pen devices have higher levels of satisfaction as compared to those using urinary HMG by means of conventional syringes.

Keywords: follicle stimulating hormone; follitropin alpha; in-vitro fertilization; infertility; luteinizing hormone; lutropin alpha; urinary gonadotrophins.

Figure 1

Meta-analysis of randomized trials of hMG versus rFSH following a long down-regulation protocol for the outcome of live births. Adapted with permission from Coomarasamy A, Afnan M, Cheema D, van der Veen F, Bossuyt PM, van Wely M. Urinary hMG versus recombinant FSH for controlled ovarian hyperstimulation following an agonist long down-regulation protocol in IV F or ICSI treatment: a systematic review and meta-analysis. Hum Reprod. 2008;23(2):310–315. Copyright © 2008 Oxford University Press. Abbreviations: HMG, human menopausal gonadotropin; RFSH, recombinant follicle stimulating hormone.

Figure 2

Meta-analysis of randomized trials of hMG versus rFSH for the outcome of pregnancy rate per patient in women undergoing ovulation induction for subfertility associated with polycystic ovarian syndrome. Bayram N, van Wely M, van Der Veen F. Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. 2001;2(2):CD002121. Copyright © Cochrane Collaboration, reproduced with permission. Abbreviations: HMG, human menopausal gonadotropin; RFSH, recombinant follicle stimulating hormone.