medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-13-34-41medsovet-6397Research ArticleРепродуктивное здоровье и ВРТReproductive health and ARTАнализ клинической эффективности человеческих менопаузальных гонадотропинов в программе вспомогательных репродуктивных технологийAnalysis of the clinical efficiency of human menopausal gonadotropins in the assisted reproductive technology programhttps://orcid.org/0000-0002-0545-1607ДрапкинаЮ. С.DrapkinaYu. A.

Драпкина Юлия Сергеевна, к.м.н., врач акушер-гинеколог, отделение вспомогательных технологий в лечении бесплодия имени профессора Б.В. Леонова 

117997, Россия, Москва, ул. Академика Опарина, д. 4

Julia S. Drapkina, Cand. Sci. (Med.), Obstetrician-Gynecologist, Professor B.V. Leonov Department of Assisted Technologies in Infertility Treatment

4, Academician Oparin St., Moscow, 117997, Russia 

julia.drapkina@gmail.comhttps://orcid.org/0000-0003-1396-7272МакароваН. П.MakarovaN. P.

Макарова Наталья Петровна, д.б.н., ведущий научный сотрудник, старший эмбриолог, отделение вспомогательных технологий в лечении бесплодия имени профессора Б.В. Леонова 

117997, Россия, Москва, ул. Академика Опарина, д. 4

Natalya P. Makarova, Dr. Sci. (Biol.), Leading researcher, Senior Embryologist, Professor B.V. Leonov Department of Assisted Technologies in Infertility Treatment

4, Academician Oparin St., Moscow, 117997, Russia 

n_makarova@oparina4.ruhttps://orcid.org/0000-0003-4866-8002СмольниковаВ. Ю.SmolnikovaV. Yu.

Смольникова Вероника Юрьевна, д.м.н., ведущий научный сотрудник, отделение вспомогательных технологий в лечении бесплодия имени профессора Б.В. Леонова 

117997, Россия, Москва, ул. Академика Опарина, д. 4

Veronika Yu. Smolnikova, Dr. Sci. (Med.), Leading Researcher, Professor B.V. Leonov Department of Assisted Technologies in Infertility Treatment

4, Academician Oparin St., Moscow, 117997, Russia 

v_smolnikova@oparina4.ruНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation2021151020210133441Copyright © Драпкина Ю.С., Макарова Н.П., Смольникова В.Ю., 20212021Драпкина Ю.С., Макарова Н.П., Смольникова В.Ю.Drapkina Y.A., Makarova N.P., Smolnikova V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6397Введение

Введение. Для повышения эффективности программ вспомогательных репродуктивных технологий продолжается сравнительный анализ мочевых и рекомбинантных гонадотропинов. Особый интерес представляет выявление отдельных групп пациентов с максимальной эффективностью применения определенных препаратов для стимуляции функции яичников в программе вспомогательных репродуктивных технологий.

Цель

Цель. Провести анализ применения препарата Менопур Мультидоза 1200 МЕ для овариальной стимуляции в протоколах вспомогательных репродуктивных технологий с аГнРГ или антГнРГ в существующей клинической практике.

Материалы и методы

Материалы и методы. В исследование ретроспективно было включено 4 080 женщин в возрасте 20–43 лет. У 65,8% пациенток стимуляция функции яичников в программе вспомогательных репродуктивных технологий проводилась по протоколу с антГнРГ, у 34,2% женщин – по протоколу с аГнРГ с использованием препарата Менопур Мультидоза 1200 МЕ с или без дополнительного применения препарата Менопур 75 МЕ.

Результаты

Результаты. Были проанализированы клинико-лабораторные данные пациенток, параметры стимулированного цикла, характеристики эмбриологического этапа и результаты программы вспомогательных репродуктивных технологий. Частота получения дегенеративных ооцитов не превышала 5%. Относительное количество бластоцист хорошего качества составляло 59,9%, при этом у пациенток в старшей возрастной группе данный показатель соответствовал 54,6. Средняя частота наступления беременности у пациенток в группе «Менопур Мультидоза 1200 МЕ п/к» составляла 39,3%, что соответствует высоким показателям эффективности программы вспомогательных репродуктивных технологий.

Выводы

Выводы. Назначение высокоочищенных чМГ (Менопур Мультидоза 1200 МЕ) для стимуляции функции яичников у пациенток разного возраста сопровождается получением адекватного количества зрелых ооцитов, бластоцист хорошего качества, а также удовлетворительными показателями наступления клинической беременности. Таким образом, высокоочищенные чМГ не уступают р-ФСГ в отношении эффективности программ вспомогательных репродуктивных технологий ВРТ.

Introduction

Introduction. Comparative analysis of urinary and recombinant gonadotropins is ongoing to improve the efficiency of assisted reproductive technology programs. Particular interest focused on the identification of individual groups of patients with maximal efficacy of using certain ovarian stimulation drugs in an assisted reproductive technology program.

Objective

Objective. To review the application of Menopur Multidose 1200 IU for ovarian stimulation in assisted reproductive technology protocols with gonadotropin-releasing hormone agonists (GnRH) or gonadotropin-releasing hormone antagonists (GnRH antagonists) in the current clinical practice.

Materials and methods

Materials and methods. The study retrospectively enrolled 4,080 women aged 20-43 years. Ovarian stimulation in the Assisted Reproductive Technology program was performed using the GnRH antagonist protocol in 65.8% of patients and the GnRH agonist protocol with Menopur Multidose 1200 IU with or without the additional Menopur 75 IU in 34.2% of women.

Results

Results. Clinical and laboratory data of the patients, stimulated cycle parameters, characteristics of the embryological stage, and results of the assisted reproductive technology program were analyzed. The frequency of obtaining degenerated oocytes did not exceed 5%. The relative number of blastocysts of good quality was 59.9%, while for patients in the older age group, the figure was 54.6. The average pregnancy rate in patients in the “Menopur Multidose 1200 IU p/k” group was 39.3%, which corresponds to high-performance indicators of the assisted reproductive technology program.

Conclusions

Conclusions. Administration of highly purified human menopausal gonadotropin (hMG) (Menopur Multidose 1200 IU) to stimulate ovarian function in patients of different ages is accompanied by an adequate number of mature oocytes, good quality blastocysts, and satisfactory clinical pregnancy rates. Thus, highly purified human menopausal gonadotropin is not inferior to recombinant follicle-stimulating hormone(r-FSH) concerning the efficacy of assisted reproductive technology programs.

вспомогательные репродуктивные технологииВРТгонадотропиныовариальная стимуляциябеременностьродычМГр-ФСГбесплодиеassisted reproductive technologiesARTgonadotropinsovarian stimulationpregnancychildbirthhMGr-FSHinfertilityReferencesКорсак В.С., Долгушина Н.В., Корнеева И.В., Колода Ю.А., Смирнова А.А., Аншина М.Б. и др. Женское бесплодие: клинические рекомендации. 2021. М.; 2021. 81 c. Режим доступа: https://rd1.medgis.ru/uploads/userfiles/shared/StandartMed/Protokol-acusher/jenskoe-besplodie-2021.pdf.Korsak V.S., Dolgushina N.V., Korneyeva I.V., Koloda YU.A., Smirnova A.A., Anshina M.B. et al. Female infertility: clinical guidelines. 2021. Moscow; 2021. 81 p. (In Russ.) Available at: https://rd1.medgis.ru/uploads/userfiles/shared/StandartMed/Protokol-acusher/jenskoe-besplodie-2021.pdf.Alper M.M., Fauser B.C. Ovarian stimulation protocols for IVF: is more better than less? Reprod Biomed Online. 2017;34(4):345–353. https://doi.org/10.1016/j.rbmo.2017.01.010.Alper M.M., Fauser B.C. Ovarian stimulation protocols for IVF: is more bet ter than less? Reprod Biomed Online. 2017;34(4):345–353. https://doi.org/10.1016/j.rbmo.2017.01.010.Howie R., Kay V. Controlled ovarian stimulation for in-vitro fertilization. Br J Hosp Med (Lond). 2018;79(4):194–199. https://doi.org/10.12968/hmed.2018.79.4.194.Howie R., Kay V. Controlled ovarian stimulation for in-vitro fertilization. Br J Hosp Med (Lond). 2018;79(4):194–199. https://doi.org/10.12968/hmed.2018.79.4.194.Van Horne A.K., Robinson R., Bates G.W., Arthur N., Neal G.S., Propst A. The Impact of Low Luteinizing Hormone Levels on Implantation and Pregnancy Rates in IVF-ET Cycles Using Recombinant FSH and Ganirelix Acetate®. Fertil Steril. 2005;83(5 Suppl.):S32. https://doi.org/10.1016/j.fertnstert.2005.01.082.Van Horne A.K., Robinson R., Bates G.W., Arthur N., Neal G.S., Propst A. The Impact of Low Luteinizing Hormone Levels on Implantation and Pregnancy Rates in IVF-ET Cycles Using Recombinant FSH and Ganirelix Acetate®. Fertil Steril. 2005;83(5 Suppl.):S32. https://doi.org/10.1016/j.fertnstert.2005.01.082.van der Linden M., Buckingham K., Farquhar C., Kremer J.A., Metwally M. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev. 2015;2015(7):CD009154. https://doi.org/10.1002/14651858.CD009154.pub3.van der Linden M., Buckingham K., Farquhar C., Kremer J.A., Metwally M. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev. 2015;2015(7):CD009154. https://doi.org/10.1002/14651858.CD009154.pub3.Out H., Mannaeris B., Driessen S., Bennink H. Recombinant FSH (rFSH; Puregon) in assisted reproduction: more oocytes, more pregnancies. Results from five comparative studies. Hum Reprod Update. 1996;2(2):162–171. https://doi.org/10.1093/humupd/2.2.162.Out H., Mannaeris B., Driessen S., Bennink H. Recombinant FSH (rFSH; Puregon) in assisted reproduction: more oocytes, more pregnancies. Results from five comparative studies Hum Reprod Update. 1996;2(2):162–171. https://doi.org/10.1093/humupd/2.2.162.Levi Setti P.E., Alviggi C., Colombo G.L., Pisanelli C., Ripellino C., Longobardi S. et al. Human recombinant follicle stimulating hormone (rFSH) compared to urinary human menopausal gonadotropin (HMG) for ovarian stimulation in assisted reproduction: a literature review and cost evaluation. J Endoc Investig. 2015;38(5):497–503. https://doi.org/10.1007/s40618-014-0204-4.Levi Setti P.E., Alviggi C., Colombo G.L., Pisanelli C., Ripellino C., Longobardi S. et al. Human recombinant follicle stimulating hormone (rFSH) compared to urinary human menopausal gonadotropin (HMG) for ovarian stimulation in assisted reproduction: a literature review and cost evaluation. J Endoc Investig. 2015;38(5):497–503. https://doi.org/10.1007/s40618-014-0204-4.Wade L., Eriksson K., Sluss P.M., Hall J.E. Serum half-life of pituitary gonadotropins is decreased by sulfonation and increased by sialylation in women. J Clin Endocrin Metabol. 2009;94(3):958–964. https://doi.org/10.1210/jc.2008-2070.Wade L., Eriksson K., Sluss P.M., Hall J.E. Serum half-life of pituitary gonad otropins is decreased by sulfonation and increased by sialylation in women. J Clin Endocrin Metabol. 2009;94(3):958–964. https://doi.org/10.1210/jc.2008-2070.Orvieto R. HMG versus recombinant FSH plus recombinant LH in ovarian stimulation for IVF: does the source of LH preparation matter? Reprod Biomed Online. 2019;39(6):1001–1006. https://doi.org/10.1016/j.rbmo.2019.08.010.Orvieto R. HMG versus recombinant FSH plus recombinant LH in ovarian stimulation for IVF: does the source of LH preparation matter? Reprod Biomed Online. 2019;39(6):1001–1006. https://doi.org/10.1016/j.rbmo.2019.08.010.Frydman R., Howles C.M., Truong F. for The French Multicentre Trialists. A double-blind, randomized study to compare recombinant human follicle stimulating hormone (FSH; Gonal-F) with highly purified urinary FSH (Metrodin) HP) in women undergoing assisted reproductive techniques including intracytoplasmic sperm injection. Hum Reprod. 2000;15(3):520–525. https://doi.org/10.1093/humrep/15.3.520.Frydman R., Howles C.M., Truong F. for The French Multicentre Trialists. A double-blind, randomized study to compare recombinant human follicle stimulating hormone (FSH; Gonal-F) with highly purified urinary FSH (Metrodin) HP) in women undergoing assisted reproductive techniques including intracytoplasmic sperm injection. Hum Reprod. 2000;15(3):520–525. https://doi.org/10.1093/humrep/15.3.520.Chen C.D., Chiang Y.T., Yang P.K., Chen M.J., Chang C.H., Yang Y.S., Chen S.U. Frequency of low serum LH is associated with increased early pregnancy loss in IVF/ICSI cycles. Reprod Biomed Online. 2016;33(4):449–457. https://doi.org/10.1016/j.rbmo.2016.07.001.Chen C.D., Chiang Y.T., Yang P.K., Chen M.J., Chang C.H., Yang Y.S., Chen S.U. Frequency of low serum LH is associated with increased early pregnancy loss in IVF/ICSI cycles. Reprod Biomed Online. 2016;33(4):449–457. https://doi.org/10.1016/j.rbmo.2016.07.001.Berndt S., Perrier d’Hauterive S., Blacher S., Péqueux C., Lorquet S., Munaut C. et al. Angiogenic activity of human chorionic go- nadotropin through LH receptor activation on endothelial and epithelial cells of the endometrium. FASEB J. 2006;20(14):2630–2632. https://doi.org/10.1096/fj.06-5885fje.Berndt S., Perrier d’Hauterive S., Blacher S., Péqueux C., Lorquet S., Munaut C. et al. Angiogenic activity of human chorionic go- nadotropin through LH receptor activation on endothelial and epithelial cells of the endometrium. FASEB J. 2006;20(14):2630–2632. https://doi.org/10.1096/fj.06-5885fje.Ruvolo G., Bosco L., Pane A., Morici G., Cittadini E., Roccheri M.C. Lower apoptosis rate in human cumulus cells after administration of recombinant luteinizing hormone to women undergoing ovarian stimulation for in vitro fertilization procedures. Fertil Steril. 2007;87(3):542–546. https://doi.org/10.1016/j.fertnstert.2006.06.059.Ruvolo G., Bosco L., Pane A., Morici G., Cittadini E., Roccheri M.C. Lower apoptosis rate in human cumulus cells after administration of recombi nant luteinizing hormone to women undergoing ovarian stimulation for in vitro fertilization procedures. Fertil Steril. 2007;87(3):542–546. https://doi.org/10.1016/j.fertnstert.2006.06.059.Zamah A.M., Hsieh M., Chen J., Vigne J.L., Rosen M.P., Cedars M.I., Conti M. Human oocyte maturation is dependent on LH-stimulated accumulation of the epidermal growth factor-like growth factor, amphiregulin. Hum Reprod. 2010;25(10):2569–2578. https://doi.org/10.1093/humrep/deq212.Zamah A.M., Hsieh M., Chen J., Vigne J.L., Rosen M.P., Cedars M.I., Conti M. Human oocyte maturation is dependent on LH-stimulated accumulation of the epidermal growth factor-like growth factor, amphiregulin. Hum Reprod. 2010;25(10):2569–2578. https://doi.org/10.1093/humrep/deq212.Gleicher N., Kushnir V.A., Barad D.H. Worldwide decline of IVF birth rates and its probable causes. Hum Reprod Open. 2019;2019(3):hoz017. https://doi.org/10.1093/hropen/hoz017.Gleicher N., Kushnir V.A., Barad D.H. Worldwide decline of IVF birth rates and its probable causes. Hum Reprod Open. 2019;2019(3):hoz017. https://doi.org/10.1093/hropen/hoz017.Lehert P., Kolibianakis E.M., Venetis C.A., Schertz J., Saunders H., Arriagada P. et al. Recombinant human follicle-stimu- lating hormone (r-hFSH) plus recombinant luteinizing hormone versus r-hFSH alone for ovarian stimulation during assisted repro-ductive technology: systematic review and metaanalysis. Repr Biol Endocrin. 2014;12:17. https://doi.org/10.1186/1477-7827-12-17.Lehert P., Kolibianakis E.M., Venetis C.A., Schertz J., Saunders H., Arriagada P. et al. Recombinant human follicle-stimu- lating hormone (r-hFSH) plus recombinant luteinizing hormone versus r-hFSH alone for ovarian stimulation during assisted repro-ductive technology: system atic review and metaanalysis. Repr Biol Endocrin. 2014;12:17. https://doi.org/10.1186/1477-7827-12-17.Vuong T.N., Phung H.T., Ho M.T. Recombinant follicle-stimulating hormone and recombinant luteinizing hormone versus recombinant follicle-stimulating hormone alone during GnRH antagonist ovarian stimulation in patients aged ≥35 years: a randomized controlled trial. Hum Reprod. 2015;30(5):1188–1195. https://doi.org/10.1093/humrep/dev038.Vuong T.N., Phung H.T., Ho M.T. Recombinant follicle-stimulating hormone and recombinant luteinizing hormone versus recombinant follicle stimulating hormone alone during GnRH antagonist ovarian stimulation in patients aged ≥35 years: a randomized controlled trial. Hum Reprod. 2015;30(5):1188–1195. https://doi.org/10.1093/humrep/dev038.König T.E., van der Houwen L.E., Overbeek A., Hendriks M.L., Beutler Beemsterboer S.N., Kuchenbecker W.K. et al. Recombinant LH supplementation to a standard GnRH antagonist protocol in women of 35 years or older undergoing IVF/ICSI: a randomized controlled multicentre study. Hum Reprod. 2013;28(10):2804–2812. https://doi.org/10.1093/humrep/det266.König T.E., van der Houwen L.E., Overbeek A., Hendriks M.L., Beutler Beemsterboer S.N., Kuchenbecker W.K. et al. Recombinant LH supplemen tation to a standard GnRH antagonist protocol in women of 35 years or older undergoing IVF/ICSI: a randomized controlled multicentre study. Hum Reprod. 2013;28(10):2804–2812. https://doi.org/10.1093/humrep/det266.Mochtar M.H., Danhof N., Olugbenga Ayeleke R., van der Veen F., van Wely M. Recombinant luteinizing hormone (rLH) and recombinant follicle stimulating hormone (rFSH) for ovarian stimulation in IVF/ICSI cycles. Cochrane Database Syst Rev. 2017;(5):CD005070. https://doi.org/10.1002/14651858.cd005070.pub3.Mochtar M.H., Danhof N., Olugbenga Ayeleke R., van der Veen F., van Wely M. Recombinant luteinizing hormone (rLH) and recombinant follicle stimu lating hormone (rFSH) for ovarian stimulation in IVF/ICSI cycles. Cochrane Database Syst Rev. 2017;(5):CD005070. https://doi.org/10.1002/14651858.cd005070.pub3.Краснопольская К.В., Назаренко Т.А., Бекетова А.Н., Ивахненко В.Н., Кабанова Д.И. ЛГ-содержащие рекомбинантные и мочевые гонадотропины в предупреждении ослабленной реакции яичников в программе ЭКО. Проблемы репродукции. 2013;19(4):67–70. Режим доступа: https://www.elibrary.ru/item.asp?id=20282977.Krasnopolskaia K.V., Nazarenko T.A., Beketova A.N., Ivakhnenko V.N., Kabanova D.I. LH-containing recombinant and urinary gonadotropins in the prevention of poor ovarian response in IVF-ET. Problemy reproduktsii = Russian Journal of Human Reproduction. 2013;19(4):67–70. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=20282977.Сыркашева А.Г., Агаршева М.В., Андреева М.Г., Долгушина Н.В., Калинина Е.А., Яроцкая Е.Л. Современные представления о дифференцированном подходе к выбору протокола стимуляции суперовуляции в циклах ЭКО. Акушерство и гинекология. 2016;(5):38–43. http://doi.org/10.18565/aig.2016.5.38-43.Syrkasheva A.G., Dolgushina N.V., Agarsheva M.V., Andreeva M.G., Kalinina E.A., Yarotskaya E. Current views of a differentiated approach to choosing a superovulation stimulation protocol in IVF cycles. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2016;(5):38–43. (In Russ.) http://doi.org/10.18565/aig.2016.5.38-43.Turkcapar E., Ozdener T., Batuoglu S. Influence of ovarian stimulation with HMG or recombinant FSH on OHSS prevention in PCO patients undergoing IVF. Fertil Steril. 2009;92(3):S96. https://doi.org/10.1016/j.fertnstert.2009.07.1042.Turkcapar E., Ozdener T., Batuoglu S. Influence of ovarian stimulation with HMG or recombinant FSH on OHSS prevention in PCO patients undergo ing IVF. Fertil Steril. 2009;92(3):S96. https://doi.org/10.1016/j.fertnstert.2009.07.1042.Al-Inany H.G., Abou-Setta A.M., Aboulghar M.A., Mansour R.T., Serour G.I. Efficacy and safety of human menopausal gonadotrophins versus recombinant FSH: a meta-analysis. Reprod Biomed Online. 2008;16(1):81–88. https://doi.org/10.1016/s1472-6483(10)60559-7.Al-Inany H.G., Abou-Setta A.M., Aboulghar M.A., Mansour R.T., Serour G.I. Efficacy and safety of human menopausal gonadotrophins versus recom binant FSH: a meta-analysis. Reprod Biomed Online. 2008;16(1):81–88. https://doi.org/10.1016/s1472-6483(10)60559-7.Mak S.M., Wong W.Y., Chung H.S., Chung P.W., Kong G.W., Li T.C., Cheung L.P. Effect of mid-follicular phase recombinant LH versus urinary HCG supplementation in poor ovarian responders under- going IVF – a prospective double-blinded randomized study. Reprod Biomed Online. 2017;34(3):258–266. http://doi.org/10.1016/j.rbmo.2016.11.014.Mak S.M., Wong W.Y., Chung H.S., Chung P.W., Kong G.W., Li T.C., Cheung L.P. Effect of mid-follicular phase recombinant LH versus urinary HCG supplementation in poor ovarian responders under- going IVF – a prospective double-blinded randomized study. Reprod Biomed Online. 2017;34(3):258–266. http://doi.org/10.1016/j.rbmo.2016.11.014.Balasch J, Fábregues F. LH in the follicular phase: neither too high nor too low. Reprod Biomed Online. 2006;12(4):406–415. https://doi.org/10.1016/s1472-6483(10)61991-8.Balasch J, Fábregues F. LH in the follicular phase: neither too high nor too low. Reprod Biomed Online. 2006;12(4):406–415. https://doi.org/10.1016/s1472-6483(10)61991-8.Cabrera R.A., Stadtmauer L., Mayer J.F., Gibbons W.E., Oehninger S. Follicular phase serum levels of luteinizing hormone do not influence delivery rates in in vitro fertilization cycles down-regulated with a gonadotropin-releasing hormone agonist and stimulated with re- combinant follicle-stimulating hormone. Fertil Steril. 2005;83(1):42–48. https://doi.org/10.1016/j.fertnstert.2004.06.050.Cabrera R.A., Stadtmauer L., Mayer J.F., Gibbons W.E., Oehninger S. Follicular phase serum levels of luteinizing hormone do not influence delivery rates in in vitro fertilization cycles down-regulated with a gonadotropin-releasing hormone agonist and stimulated with re-combi nant follicle-stimulating hormone. Fertil Steril. 2005;83(1):42–48. https://doi.org/10.1016/j.fertnstert.2004.06.050.Hompes P.G., Broekmans F.J., Hoozemans D.A., Schats R., FIRM group. Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization-intracytoplasmic sperm injection patients. Fertil Steril. 2008;89(6):1685–1693. https://doi.org/10.1016/j.fertnstert.2007.05.039.Hompes P.G., Broekmans F.J., Hoozemans D.A., Schats R., FIRM group. Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization-intracytoplasmic sperm injection patients. Fertil Steril. 2008;89(6):1685–1693. https://doi.org/10.1016/j.fertnstert.2007.05.039.

The authors declare that there are no conflicts of interest present.