The In-vitro Effect of Different Gonadotropins Types and Combinations on Final Follicular Maturation

Yuval Yung Adva Aizer Sharon Avhar Maydan Sara Tieb Tieb Raoul Orvieto
Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), and Sackler School of Medicine, Tel Aviv University, Israel

Introduction:
Nowadays, different modes and timing of GnRH-agonist combined with hCG trigger for final follicular maturation have been described. While LH+FSH are the naturally occurring final follicular maturation trigger, hCG is commonly used during the stimulated cycle, and recently the introduction of the Dual/Double trigger combines LH+FSH+hCG.

Objective:
To investigate the in-vitro effect on the expression of the reproduction-related genes in human granulosa cells (GCs) exposed to the aforementioned triggers with different types and combinations of gonadotropins.

Design:
Mural GCs were obtained from follicular fluid aspirated during IVF protocol. GCs were seeded in culture for four days with daily medium exchange followed by administration of either hCG (1U/ml), FSH (1U/ml), LH (8U/ml), or combinations for 16 h. mRNA was purified from harvested GCs and gene expression was quantitative by qPCR.

Main Outcome Measure(s):
 The expression of genes related to steroidogenesis (StAR) and follicular maturation (COX2) in GCs.

Result(s):
The naturally occurring (LH+FSH) and the Dual/Double triggers (LH+FSH+hCG) showed a trend toward higher in-vitro activations of steroidogenesis (StAR) and follicular maturation (COX2), as compared to hCG trigger. The Dual/Double trigger (LH+FSH+hCG) activates more vigorously steroidogenesis (StAR) and follicular maturation (COX2), although not statistically significant.

Conclusion(s):
Our findings are in accordance with clinical evidence demonstrating that the naturally occurring (LH+FSH) and the Dual/Double triggers (LH+FSH+hCG) result in improved in-vitro steroidogenesis (StAR) and follicular maturation (COX2), as compared to hCG trigger.