Ovulation Induction

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Hans van der Slikke, MD, PhD: “It’s January of 2002, and we’re in Fort Lauderdale, Florida at the Advances in Infertility Treatment Conference. Today we had a very interesting session, one of the main sessions, I may say, of this Conference about ovulation induction. Next to me is one of the two Chairmen of this session Matthias Bloechle from Berlin. Welcome, Matthias.” 

MatthiasBloechle, MD: “Thank you.” 

Hans van der Slikke, MD, PhD: “You are so kind to discuss this afternoon’s session for us. First, what was your main impression of this afternoon?” 

MatthiasBloechle, MD: “It was a very interesting session this afternoon beginning with more basic research by Dr. McGee and Dr. Zeleznik, and then we continued to more clinical approaches like Dr. Olivennes talking about GnRH antagonists. I was especially impressed by the contribution of Marco Filicori who gave us new insights into the control of folliculogenesis and presented brand new data about the use of low dose hCG in the late follicular phase to complete follicular maturation and at the same time to suppress the development of small folliculars so diminishing the risk of hyperstimulation syndrome. And finally, Dr. Jansen gave us an impressive presentation on highly purified hMG and discussed all of the issues that came from supporters of recombinant FSH. This was a very clear and very informative contribution too.” 

Hans van der Slikke, MD, PhD: “Yes, and in between we also had two presentations about antagonists from Bart Fauser as well. One of the main items of this afternoon was again this question of LH - is it necessary, useful, or not within the normal stimulation protocols?” 

MatthiasBloechle, MD: “Yes, this is a discussion that goes on, I think within the last five or six years when the recombinant FSH came up they told us that is not necessary to have LH within the follicular stimulation protocols. Now we’ve learned that basic use of having an LH activity seems to be the case that’s needed to induce final follicular maturation to suppress increased development of small follicles and to thereby reduce the risk of hyperstimulation syndrome by driving the leading follicles to final maturation and suppressing at the same time the occurrence of small follicles.” 

Hans van der Slikke, MD, PhD: “Yes, and that was what Marco Filicori showed us although he started with a rather high dose. Isn’t it?” 

MatthiasBloechle, MD: “You are talking about an hCG dose? 

Hans van der Slikke, MD, PhD: “Yes.” 

MatthiasBloechle, MD: “He had a study protocol where he tested different hCG doses and surprisingly even in the high dose of 200 units a day there was no negative effect as expected, for example, premature luteinization or premature rupture of follicles. That was quite surprising, even with a cumulative high dose of 200 units of hCG a day there were no negative effects but still you could proceed for final maturation and get nice follicles, and he presented the case with successive pregnancy after this treatment scheme.” 

Hans van der Slikke, MD, PhD: “Because after him as well Cees Jansen with Kilani showed about the same results in their double blind trials.” 

MatthiasBloechle, MD: “The Kilani study has the aspect that there are very low numbers so the statistical power of this study should not be so strong. Nevertheless, if urinary drugs are considerably less expensive than the recombinant and we have the same results there’s no reason why you should go to the recombinant drugs because we are all responsible for the budgets of our patients as well as the budgets of our health insurance and our healthcare systems in our society. But the most impressive thing was we can use hGG for final follicular maturation; I’m very interested if that will be the way we will perform stimulation in the future.” 

Hans van der Slikke, MD, PhD: “But how do you perform your stimulations yourself?” 

MatthiasBloechle, MD: “Up to now we go the traditional way using different types of gonadotrophins, we have a high proportion of highly purified menotrophins and we have as well a certain proportion of recombinant drugs. I think it’s important to get experience with your own results and to compare each to the other regiment and to prove to yourself every month and every year in showing what is the best way within your own clinical setting.” 

Hans van der Slikke, MD, PhD: “We are looking forward to the ovulation induction session in about two years. I’m curious how this view will be at that time after several other trials that are going on at this moment.” 

MatthiasBloechle, MD: “That will be very promising and I’m very interested in that.” 

Hans van der Slikke, MD, PhD: “Thank you very much.” 

MatthiasBloechle, MD: “Thank you very much.”