After examining the use of gonadotropins in a variety of infertility therapies, Richard Reindollar and Marlene Goldman at DMS and the DHMC questioned their effectiveness and proposed a paradigm shift away from high doses of gonadotropins in these treatments.
Many couples experiencing infertility seek treatment in the hopes of conceiving. Infertility treatment was just in its developing stages during the last century. In 1960, Lunenfeld, a European doctor, was the first to use gonadotropins for ovulation induction. This therapy was rapidly exported to the US, but its negative effects were soon discovered, as many women reported having ovarian hyper–stimulation syndrome (OHSS) as a result. Furthermore, gonadotropin therapy was associated with higher risks of having high order multiple births.
In examining current therapies, Reindollar and Goldman looked at the outcome of a randomized, clinical trial carried out by the National Collaborative Reproductive Medicine Network. This trial compared four treatments: intracervical insemination (ICI), intrauterine insemination (IUI), FSH/ICI, and FSH/IUI. FSH, or follicle– stimulating hormone, is a gonadotropin that has been used in infertility therapies for many years. The results showed that the per cycle pregnancy rate for FSH/IUI was similar to that for clomiphene citrate (CC)/IUI at 9% per cycle, but resulted in far greater cases of high order multiple births. (Clomiphene citrate is a selective estrogen receptor modulator that increases production of gonadotropins.)
In looking at mild gonadotropin stimulation in IVF protocols, Reindollar and Goldman saw several benefits. Not only is there reduced risk for OHSS and discomfort, but there is evidence that using a lower dosage of gonadotropins results in better quality embryos. Yet there are challenges in making mild IVF stimulation more commonly used in the US. The US has traditionally used high dose protocols and kept more embryos for cryopreservation. When couples look for IVF centers, they often think, “more is better.” Reindollar and Goldman believe it is important to continue developing treatments that will lower the costs, time, stress, and dangers associated with infertility treatments. They believe gonadotropin therapy will soon be seen as a “relic of the twentieth century.”