Gonadotrophins The role of carbohydrate moiety

 

Types of gonadotrophins preparations:-Does result vary?

The carbohydrate moiety:- The degree of sialylation and sulfation-are the changes  in the carbohydrate part of G’trophin-. These  two (sialylation and sulfation)     modify/ control the bioactivity of G’trophin molecules in diff batches. Receptor binding and metabolic clearance varies according to such sialylation and sulfation  which often we the clinicians forget . .

The degree of sialylation correlates with acidic moleculeàdifferent FSH isoforms. Now by using optimized chromatographic techniques –a predetermined & predefined isoforms can be prepared from u-FSH.(Bravelle).Bravelle contain less acidic residue. Less acidic form is better to yield good results as in Bravelle.

1)           Protein content as purity:-

2)           Few points as r-FSH:- Follitrophin-α   (  Gonal-F)              β

3)           The efficacy of p-FSH vs r-FSH in non-down regulated cycles and down regulated cycles were little evaluated so far.

 

4)           How to judge & compare between two such types of gonadotrophins ? The primary end point is Ovulation, but secondary end points were a) whether monofollicular development  b) Size of follicles-How many 12,>15 & > 18 mm follicles are there? c)Pregancy rate  d)Endometrial thickness   d) Incidence of OHSS  f) Inj sites pain/ reactions’) h) Multiple preg rates

 

5)           Choice of gonadotrophins? - Bothe p-urinary FSH (ovulation rate was 85%) & rFSH (91%) are equally effective.

 

6)           Efficacy comparison between two types of gonadotrophins:-Pregancy rate of singletons in u-FSH was 15% in each group.

7)           Start with Gonadotrophins 75-150 I.U. OD from Day3:- better at evening hours. & on day 8 morning estimate serum E2. Once the serum E2 starts rising then, alt day

8)           The adenohypophysis secretes nine other hormones: 1) growth hormone (GH) promotes growth; 2) corticotropin (ACTH) causes the adrenal cortex to secrete corticosteroid hormones;3)  follicle-stimulating hormone (FSH)  4)  luteinizing hormone (LH) interact to regulate the function of the gonads; 5)  prolactin (PRL) causes milk synthesis, 6) thyroid -stimulating hormones & 7)  endorphins, and growth hormone. The acidophils secrete GH (somatotropes) and prolactin (mammotropes). Basophils secrete TSH (thyrotropes), LH (gonadotropes), FSH (gonadotrophs), and ACTH (corticotrophs).