406
In those patients who received hCG, Pergogreen therapy lasted for 10.0 - 1.8 days and a mean of 33.0 --- 9.9 ampoules was utilized. These values are consistent with those from other studies in which a GnRH analogue agonist was employed in combination with hMG (6). The mean estradiol level on the day of hCG was 1260 -+ 531 pg/ml. Again, this mean value is similar to those recorded in other studies utilizing Pergonal (75 IU FSH, 75 IU LH), supporting the concept that only low levels of L H are required for normal ovarian steroidogenesis (1). Finally, no patient developed true clinical symptoms of hyperstimulation syndrome. To prevent such an event, four patients did not receive hCG because of elevated or rapidly rising plasma E 2 concentrations and two patients had no embryos replaced because of elevafed plasma E2 concentrations. Overall, using an hMG containing a reduced amount of L H leads to encouraging high pregnancy and low miscarriage rates. These results support previous reports on the deleterious effects of L H on follicular development. However, further prospective comparative studies are needed to confirm these preliminary data in order to determine if Pergogreen offers better perspectives than conventional gonadotropin preparations.
SHORT COMMUNICATIONS
6. Edelstein MC, Brzyski RG, Hones GS: Equivalency of human menopausal gonadotropin and follicle-stimulating hormone stimulation after gonadotropin-releasing hormone agonist suppression. Fertil Steril 1990;53:475--481
J. M. Antoine 1 J. Salat-Baroux S. Alvarez D. Cornet C. Tibi Department of Obstetrics and Gynaecology and Biology of Reproduction Service Pr Salat-Baroux Hrpital Tenon 4 rue de la Chine 70520 Paris, France V. Brieu Laboratories Serono SA Boulogne, France J. Mandelbaum M. Plachot Unit6 173 INSERM Hrpital Necker Paris, France 1 TO whom correspondence should be addressed.
CLAMART,
FRANCE
ACKNOWLEDGMENT We are grateful to Serono France Laboratories for their financial support.
H o w to H a l v e the Prematurity Rates o f in Vitro Fertilization Pregnancies in 4 D a y s
REFERENCES 1. Hillier SG: Ovarian manipulation with pure gonadotrophins. J Endocrinol 1990;127:1--6 2. Howles CM, McNamee MC, Edwards RG: Follicular development and early luteal function of conceptional and nonconceptional cycles after human in-vitro fertilisation: Endocrine correlates. Hum Reprod 1987;2:17-21 3. Antoine JM, Salat-Baroux J, Alvarez S, Cornet D, Tibi C, Mandelbaum J, Plachot M: Ovarian stimulation using human menopausal gonadotrophins with or without LHRH analogues in a long protocol for in-vitro fertilization: A prospective randomized comparison. Hum Reprod 1990;5:565-569 4. Bernardus RE, Jones GS, Acosta AA, Garcia JE, Liu HC, Jones DL, Rozenwaks Z: The significance of the ratio in FSH and LH in induction of multiple follicle growth. Fertil Steril 1985;43:373-378 5. Navot D, Rozenwaks Z: The use of follicle-stimulating hormone for controlled ovarian hyperstimulation in in vitro fertilisation. J Vitro Feat Embryo Transfer 1988;5:3-13
Submitted: May 12, 1992 Accepted: May 13, 1992
Recent studies (1,2) have pointed out the increased risk for obstetrical complications in pregnancies resulting from assisted reproductive technologies. This increased risk, for prematurity rate, for example, has been related to the high percentage of multiple pregnancies obtained with these methods. But, the prematurity rate seems also to be increased in singleton pregnancies (1,2). These studies have raised a question about the role played by IVF in the increased risk for preterm birth. Journal of Assisted Reproduction and Genetics, Vol. 9, No. 4, 1992
SHORT COMMUNICATIONS
Among the factors that can explain differences between spontaneous and induced pregnancies, the characteristics of the infertile population can play an important role, and recently some studies (3,4) have shown that infertile couples have a higher risk of obstetrical complications than fertile couples even without IVF. We want to point out the fact that the method of calculating the duration of IVF pregnancies can also be involved. Usually, the term of IVF pregnancies is estimated by adding 14 days to the date of oocyte retrieval to obtain a theorical number of weeks of amenorrhea. This supposes that ovulation occurs at the 14th day in natural cycles on average. However, the literature is not totally consistent on this point. For example, Spira et al. (5) found a mean hypothermic phase of 18 days for 894 patients trying to obtain a natural pregnancy. In the study of 162 IVF singleton pregnancies conceived in Clamart, France, between 1987 and 1989, the prematurity rate (
In those patients who received hCG, Pergogreen therapy lasted for 10.0 - 1.8 days and a mean of 33.0 --- 9.9 ampoules was utilized. These values are consistent with those from other studies in which a GnRH analogue agonist was employed in combination with hMG (6). The mean estradiol level on the day of hCG was 1260 -+ 531 pg/ml. Again, this mean value is similar to those recorded in other studies utilizing Pergonal (75 IU FSH, 75 IU LH), supporting the concept that only low levels of L H are required for normal ovarian steroidogenesis (1). Finally, no patient developed true clinical symptoms of hyperstimulation syndrome. To prevent such an event, four patients did not receive hCG because of elevated or rapidly rising plasma E 2 concentrations and two patients had no embryos replaced because of elevafed plasma E2 concentrations. Overall, using an hMG containing a reduced amount of L H leads to encouraging high pregnancy and low miscarriage rates. These results support previous reports on the deleterious effects of L H on follicular development. However, further prospective comparative studies are needed to confirm these preliminary data in order to determine if Pergogreen offers better perspectives than conventional gonadotropin preparations.
SHORT COMMUNICATIONS
6. Edelstein MC, Brzyski RG, Hones GS: Equivalency of human menopausal gonadotropin and follicle-stimulating hormone stimulation after gonadotropin-releasing hormone agonist suppression. Fertil Steril 1990;53:475--481
J. M. Antoine 1 J. Salat-Baroux S. Alvarez D. Cornet C. Tibi Department of Obstetrics and Gynaecology and Biology of Reproduction Service Pr Salat-Baroux Hrpital Tenon 4 rue de la Chine 70520 Paris, France V. Brieu Laboratories Serono SA Boulogne, France J. Mandelbaum M. Plachot Unit6 173 INSERM Hrpital Necker Paris, France 1 TO whom correspondence should be addressed.
CLAMART,
FRANCE
ACKNOWLEDGMENT We are grateful to Serono France Laboratories for their financial support.
H o w to H a l v e the Prematurity Rates o f in Vitro Fertilization Pregnancies in 4 D a y s
REFERENCES 1. Hillier SG: Ovarian manipulation with pure gonadotrophins. J Endocrinol 1990;127:1--6 2. Howles CM, McNamee MC, Edwards RG: Follicular development and early luteal function of conceptional and nonconceptional cycles after human in-vitro fertilisation: Endocrine correlates. Hum Reprod 1987;2:17-21 3. Antoine JM, Salat-Baroux J, Alvarez S, Cornet D, Tibi C, Mandelbaum J, Plachot M: Ovarian stimulation using human menopausal gonadotrophins with or without LHRH analogues in a long protocol for in-vitro fertilization: A prospective randomized comparison. Hum Reprod 1990;5:565-569 4. Bernardus RE, Jones GS, Acosta AA, Garcia JE, Liu HC, Jones DL, Rozenwaks Z: The significance of the ratio in FSH and LH in induction of multiple follicle growth. Fertil Steril 1985;43:373-378 5. Navot D, Rozenwaks Z: The use of follicle-stimulating hormone for controlled ovarian hyperstimulation in in vitro fertilisation. J Vitro Feat Embryo Transfer 1988;5:3-13
Submitted: May 12, 1992 Accepted: May 13, 1992
Recent studies (1,2) have pointed out the increased risk for obstetrical complications in pregnancies resulting from assisted reproductive technologies. This increased risk, for prematurity rate, for example, has been related to the high percentage of multiple pregnancies obtained with these methods. But, the prematurity rate seems also to be increased in singleton pregnancies (1,2). These studies have raised a question about the role played by IVF in the increased risk for preterm birth. Journal of Assisted Reproduction and Genetics, Vol. 9, No. 4, 1992
SHORT COMMUNICATIONS
Among the factors that can explain differences between spontaneous and induced pregnancies, the characteristics of the infertile population can play an important role, and recently some studies (3,4) have shown that infertile couples have a higher risk of obstetrical complications than fertile couples even without IVF. We want to point out the fact that the method of calculating the duration of IVF pregnancies can also be involved. Usually, the term of IVF pregnancies is estimated by adding 14 days to the date of oocyte retrieval to obtain a theorical number of weeks of amenorrhea. This supposes that ovulation occurs at the 14th day in natural cycles on average. However, the literature is not totally consistent on this point. For example, Spira et al. (5) found a mean hypothermic phase of 18 days for 894 patients trying to obtain a natural pregnancy. In the study of 162 IVF singleton pregnancies conceived in Clamart, France, between 1987 and 1989, the prematurity rate (
