[Show abstract][Hide abstract]ABSTRACT: To evaluate whether the use of transdermal hormone replacement therapy (HRT), in women within 5 years of menopause compared with women who were postmenopausal for > 5 years, would significantly influence thromboxane B2 levels, plasma viscosity and Doppler flow parameters at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries.
Thirty-five normal-weight (body mass index > 19 and < 25 kg/m(2)) postmenopausal women (age 54.6 +/- 3.9 years, mean +/- standard deviation) participated in the study and were divided into two groups (Group I: n = 19, time since menopause < 5 years; and Group II: n = 16, time since menopause > 5 years). Patients were treated with a continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every 2 months. They were studied at baseline and after 6 months (in the estrogen-only phase of the cycle).
Results showed a beneficial effect of hormone substitution after 6 months of therapy. Baseline plasma viscosity was similar in both groups, and decreased significantly after therapy in both Group I (-17.5%) and Group II (-15.6%). Plasma levels of thromboxane B(2) were similar at baseline and diminished equally in Group I and Group II (-85.6% and -85.2%, respectively) after treatment. Doppler assessment of the pulsatility index at the level of uterine, internal carotid, ophthalmic and bladder wall arteries showed no differences between groups at baseline and revealed a significant reduction of vascular impedance at the end of the treatment in both groups.
Time since menopause does not affect the potential hemodynamic benefits of HRT in normal-weight women.
Full-text available · Article · Mar 2005 · Gynecological Endocrinology
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to evaluate the effects of transdermal hormone replacement therapy on some biological cardiovascular risk factors, specifically the thromboxane B2 levels, plasma viscosity and the lipid profile. Furthermore, we investigated the Doppler flow modifications at the level of the uterine artery, the internal carotid, the ophthalmic and the bladder wall arteries, and we finally evaluated whether there were significant differences in the examined parameters between normal and overweight postmenopausal women. Forty-five postmenopausal women (mean age+/-standard deviation, 53.5+/-3.8 years) participated in the study and were divided into two groups (27 with a body mass index of < 25 kg/m2 and 18 with a body mass index of > 25 kg/m2). Patients were treated with a continous estradiol transdermal supplement and a 12-day course of medroxyprogesterone acetate every 2 months, and were studied at baseline and after 6 months (in the estrogen-only phase of the second cycle). Our results showed a beneficial effect of hormone substitution on plasma viscosity, thromboxane B2 levels and lipid profile after 6 months of therapy and significant improvements of Doppler flow parameters in the examined vessels. Furthermore, we observed a lower impact of the treatment in overweight women. In conclusion, obesity represents an additional cardiovascular risk condition and it can only partially be modified by the administration of hormone replacement therapy.
Full-text available · Article · Dec 2004 · Gynecological Endocrinology
[Show abstract][Hide abstract]ABSTRACT: To compare the plasma thromboxane, the plasma viscosity and the Doppler flow modifications induced by tibolone and by oral or transdermal continuous combined hormone replacement therapy.
Forty-two post-menopausal patients underwent either on: oral daily treatment with tibolone (2.5 mg) (Group I; n= 14); or continuous oral administration of 0.625 mg conjugated equine estrogens + medroxyprogesterone 5 mg per day (Group II; n = 14 ); or continuous estradiol transdermal supplementation, at a dose of 50 microg per day, + medroxyprogesterone 5 mg per day (Group III; n = 14 ). The duration of the study was 6 months and the patients were submitted to transvaginal ultrasonographic evaluation of pelvic organs; Doppler analysis of the uterine, internal carotid and ophthalmic arteries; thromboxane and plasma viscosity assays in basal condition, and at 1, 3 and 6 months from the beginning of the study.
Although the endometrial thickness increased significantly, there were no cases in which it exceeded the normal range (< or = 5 mm). In all the three groups, the pulsatility index of the uterine, internal carotid and ophthalmic arteries significantly decreased during the therapy showing a reduced impedance since the first month of treatment. Similar variations were observed for the peak systolic blood flow velocity of the internal carotid and ophthalmic arteries. Hormone replacement therapy and tibolone induced a deep, significant and rapid decrease in plasma thromboxane and plasma viscosity levels.
Hormone replacement therapy and tibolone seem to have beneficial effects on vascular and hemorrheological parameters.
Full-text available · Article · Aug 2004 · Maturitas
[Show abstract][Hide abstract]ABSTRACT: To compare the effects of hormone therapy (HT) on plasma viscosity and Doppler flow parameters in normal, healthy, postmenopausal women and in women with normal-tension and chronic, open-angle glaucoma.
Eight postmenopausal women with glaucoma (group I) and 15 controls (group II) were given HT. The duration of the study was 6 months, and the women were examined in basal condition and at the end of the treatment. All women underwent ultrasonographic evaluation of pelvic organs and color Doppler analysis of uterine, internal carotid, and ophthalmic arteries. Also, plasma viscosity was assayed.
The ultrasonographic analysis showed that none of the women presented with irregular endometrial echoes, polyps, or intracavitary fluid. In addition, endometrial thickness never exceeded the normal range (5 mm). Plasma viscosity and Doppler parameters significantly improved during therapy. However, the ophthalmic artery mean improvements of pulsatility index (-43% v -28%; P = 0.001), peak systolic blood flow velocity (+35% v +24%; P = 0.026), and time-averaged maximum velocity (+44% v +32%; P = 0.031) were significantly more evident in the control group than in the glaucoma group.
Although, in people with glaucoma, vasospasm can increase the risk of visual loss by inducing a retrobulbar blood flow reduction, HT seems to beneficially affect the ocular vascularization.
Full-text available · Article · Jan 2004 · Menopause
[Show abstract][Hide abstract]ABSTRACT: To evaluate the role of ultrasound and color Doppler analyses in improving the differential diagnosis of pubertal precocities.
Sixty-nine girls with premature (<8 years old) breast development and/or pubic hair growth underwent: auxological (height, weight, body mass index, skeletal maturation), hormonal (basal, gonadotropin releasing hormone (GnRH)-test, adrenocorticotropic hormone test), and sonographic (uterine and ovarian volume and endometrial echo) including color Doppler (uterine arteries) evaluations.
The uterine size was greater in girls with a pubertal response to the GnRH test (Group II, n = 16; 7.48 +/- 4.18 mL) than in those with a prepubertal response to the GnRH test (Group I, n = 17; 3.02 +/- 1.36 mL; P = 0.006), an isolated pubarche (Group III; n = 20; 2.58 +/- 1.32 mL; P < 0.001) or an isolated thelarche (Group IV, n = 16; 1.82 +/- 1.07 mL; P < 0.001). Endometrial echo was observed in 87.5%, 29.4% and 5% of girls, respectively, in Groups II, I and III. The Doppler analysis of the uterine arteries showed the lowest impedance to be in patients with a pubertal response to the GnRH test (Group II).
Sonographic and color Doppler parameters may improve the diagnosis of GnRH-dependent precocious puberty and may be useful to determine which girls need treatment.
Full-text available · Article · Sep 2003 · Ultrasound in Obstetrics and Gynecology
[Show abstract][Hide abstract]ABSTRACT: Twenty-seven girls with premature pubarche were studied by ultrasonographic and color Doppler analyses to determine the incidence of polycystic ovaries (PCO), to longitudinally assess their evolution, and to search for any hormonal correlation. The girls were submitted to auxological, clinical, and hormonal evaluation, and 21-hydroxylase deficiency was ruled out by an ACTH test. Furthermore, the girls underwent ultrasonographic and color Doppler ovarian and uterine analyses. Among girls with premature pubarche, the prevalence of PCO was 41%. Advanced skeletal maturation, tall stature, and increased hair distribution were constant in these patients. In patients with ultrasonographic and color Doppler evidence of PCO, the ovarian volume, the number of small-sized subcapsular follicles, the stromal echogenicity, and the ovarian stromal vascularization progressively increased during the study. In the whole studied population, ovarian volume correlated with the number of small-sized follicles (r = 0.719; P < 0.0001). Furthermore, a slight and inverse correlation has been found between ovarian volume and ovarian stromal artery pulsatility index (r = -536; P = 0.048). In conclusion, we affirm that PCO are greatly represented among girls with premature pubarche and progressively evolve.
Full-text available · Article · Jul 2002 · Journal of Clinical Endocrinology & Metabolism
[Show abstract][Hide abstract]ABSTRACT: Objective: To compare the efficacy of sonohysterography and hysteroscopy in the diagnosis of endometrial abnormalities. Methods: Sonohysterography was performed on 216 patients for whom transvaginal sonography had suggested an unspecific abnormal endometrial echo. The patients were divided into three groups: 106 women suffering from infertility (Group 1); 53 premenopausal (Group 2) and 57 postmenopausal women (Group 3) affected by abnormal uterine bleeding. Patients of Group 1 and 2 were examined in the early follicular phase, postmenopausal patients were randomly examined. To confirm the ultrasound diagnosis, all the patients underwent hysteroscopy. Results: In Group 1, sonohysterography showed normal cavity in 52 patients, endometrial polyps in 39, submucous myomas in 6, septate uterus in 2 and adhesions in 6 cases. In Group 2 we observed normal cavity in 6, endometrial polyps in 38, submucous myomas in 7 and suspect of carcinoma in 2 cases. In-Group 3 normal cavity, endometrial polyps, submucous myomas and suspect of carcinoma were respectively observed in 17, 36, 1 and 3 patients. Hysteroscopy confirmed the diagnosis in 99.5% of the patients. Conclusion: Our data show that SHG improves transvaginal ultrasound accuracy, is simple to perform, safe and well tolerated by the patients.
[Show abstract][Hide abstract]ABSTRACT: Enhanced vascularization appears to be important for follicular selection and maturation in both spontaneous and stimulated IVF cycles. Nitric oxide, formed in vivo from L-arginine, may play a key role in follicular maturation and ovulation.
To evaluate the role of L-arginine supplementation in controlled ovarian hyperstimulation, 37 IVF patients were divided into two groups according to ovarian stimulation protocols: group I, GnRH agonist plus pure (p)FSH plus oral L-arginine (n = 18); and group II, GnRH agonist plus pFSH plus placebo (n = 19). Hormonal, ultrasonographic and Doppler evaluations were performed, and plasma and follicular fluid nitrite/nitrate concentrations were monitored.
Thirty-two patients completed the study. In group I (n = 16), plasma L-arginine concentrations increased from (basal) 87 +/- 12 micromol to 279 +/- 31 micromol (P = 0.002) on the day of beta-HCG administration. In this group, pFSH treatment was shorter (P = 0.039) than in group II (n = 16). The number of the follicles > or =17mm was lower (P = 0.038) in group I than group II. The "good quality" embryos were fewer in number (P = 0.034) and pregnancy rate, both per patient (P = 0.024) and per embryo transfer (P = 0.019), was lower in group I. In the L-arginine group, an increased follicular fluid concentration of nitrite/nitrate was observed. On day 8 of the cycle, elevated plasma estradiol levels were associated with decreased blood flow resistances of perifollicular arteries. Follicular fluid concentrations of nitrite/nitrate were inversely correlated with embryo quality (r = -0.613; P = 0.005) and perifollicular artery pulsatility index (r = -0.609; P = 0.021).
L-Arginine supplementation may be detrimental to embryo quality and pregnancy rate during controlled ovarian hyperstimulation cycles.
Full-text available · Article · Apr 2002 · Human Reproduction
[Show abstract][Hide abstract]ABSTRACT: To evaluate the role of ultrasound and color Doppler analyses in the diagnosis of precocious puberty.
Gray-scale sonographic uterine and ovarian evaluation together with color Doppler analysis of the uterine artery were prospectively performed in 29 girls presenting with premature breast development and pubic hair growth. The values were compared with results obtained from the gonodotrophin releasing hormone stimulation test. Excluded from the study were patients with isolated thelarche or isolated pubarche and those patients with gonodotrophin releasing hormone-independent puberty and with polycystic ovaries.
According to the Tanner scale, all the girls presented a breast stage of 2-3 and pubic hair stage 2-3. The uterine size was greater in those girls who presented a pubertal response to the gonodotrophin releasing hormone test (Group II; n = 20) (8.07 +/- 4.47 mL) than in those who did not (Group I; n = 9) (3.07 +/- 1.18 mL; P = 0.001). The ovarian volume and the number of small follicles was not significantly different between the groups. On Doppler analysis, more elevated impedances were observed in Group I (pulsatility index = 3.28 +/- 0.37) than in Group II (pulsatility index = 2.29 +/- 0.19; P = 0.001) girls. The presence of a low pulsatility index (< 2.5) at the level of the uterine arteries had a high diagnostic value for precocious puberty (sensitivity 86%, specificity 100%).
Uterine artery Doppler analysis may assist the diagnosis of gonodotrophin releasing hormone-dependent precocious puberty, may be useful for the selection of those girls needing treatment, and may simplify the follow-up of girls treated for precocities.
Full-text available · Article · Apr 2002 · Ultrasound in Obstetrics and Gynecology
[Show abstract][Hide abstract]ABSTRACT: Polycystic ovarian syndrome (PCOS) is a controversial endocrine pathology and, recently, it has been suggested that the condition is hereditary. The aim of this study was to prospectively determine in daughters of patients with PCOS, by ultrasonographic (US) and colour Doppler analyses, the incidence of polycystic ovaries and search any correlation with specific hormonal parameters.
Fifteen prepubertal offspring (Group I) of patients with PCOS and 10 normal control prepubertal girls (Group II) were submitted to clinical, auxological, and basal hormonal assay. In addition all patients were submitted to US and colour Doppler ovarian and uterine evaluation.
Among Group I girls the prevalence of polycystic ovaries was 93%, whereas no subjects among Group II had polycystic ovaries. The ovarian volume (2.76 +/- 1.21 ml versus 0.87 +/- 0.46 ml; P < 0.001) and the number of small sized follicles (5.36 +/- 2.2 versus 0.75 +/- 0.92; P < 0.001) were significantly higher in Group I than Group II patients. In addition, a normal stromal score and an absent stromal vascularization was observed in the control group. The hormone levels did not differ between the two groups.
In conclusion we speculate that polycystic ovaries in childhood may be considered a sign of genetic predisposition to PCOS and that environmental factors may express the adult clinical and hormonal presentation of the syndrome.
Full-text available · Article · Apr 2002 · Human Reproduction
[Show abstract][Hide abstract]ABSTRACT: The regulation and significance of ovarian and uterine haemodynamics in human reproductive pathophysiology has been largely studied. In women, ovarian vascularization seems to be responsible for the selection and maturation of follicles both in spontaneous and stimulated IVF cycles while endometrial receptivity is related to uterine blood flow and implicated in the achievement of pregnancy. In patients who underwent to IVF cycles, the PI of both uterine and spiral arteries is significantly lower in patients who became pregnant in comparison with nonpregnant and is associated with significantly lower endometrial cell thromboxane concentrations than non pregnant patients. In poor responders women it has been demonstrated the role of l-arginine in improving uterine and follicular Doppler flow and in increasing ovarian response to gonadotrophin. Recently, in a total of 41 patients undergoing to assisted reproduction, an higher number of oocytes collected and embryos transferred was observed in normo-responders than in poor-responders patients. Furthermore follicular vascular endothelial growth factor (VEGF) resulted inversely correlated with retrieved oocytes (r = −0.942; p = 0.0017). In addition significant higher uterine and perifollicular Doppler flow resistances were observed in poor-responders women. The pregnancy rate/cycle was significantly higher in normo-responders (26%) than poor-responders (6%; p = 0.037) patients.In conclusion, vasoactive substances improve ovarian response to gonadotrophin and allow a better management of ovarian stimulation in infertile patients.
Article · Jan 2002 · Ultrasound in Obstetrics and Gynecology
[Show abstract][Hide abstract]ABSTRACT: Menopause is associated with an increase in the incidence of ischemic heart disease and stroke. Loss of ovarian function is characterized by significantly high values of blood and plasma viscosity. After the menopause, thromboxane production increases and correlates with duration of menopause. Large studies have shown that postmenopausal HRT is associated with reduction in the risk of cardiovascular disease. The aim of the study was to evaluate the plasma thromboxane and plasma viscosity in relation with Doppler flow parameters in postmenopausal patients treated with HRT. Thirty-two postmenopausal (FSH > 40 UI/L and estradiol < 100 pmol/L) women (mean age ± SD, 54.7 ± 2.9 years) participated in the study and were submitted to continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every second month. Doppler resistances at the level of uterine and internal carotid arteries, thromboxane plasma levels and plasma viscosity were analyzed in basal condition and after 1, 3 and 6 months. During hormone supplementation, the pulsatility index significantly decreased at the level of analyzed arteries. Similarly, plasma thromboxane levels and plasma viscosity were significantly reduced. Significant correlations were found between thromboxane plasma concentrations, plasma viscosity and uterine artery resistances. Thus HRT seems to be responsible for both direct and indirect modifications at the level of the vessel wall physiology.
Article · Jan 2002 · Ultrasound in Obstetrics and Gynecology
[Show abstract][Hide abstract]ABSTRACT: Objective: To prospectively evaluate the role of intratesticular vascular flow in modulating sperm function in men with obstructive and nonobstructive azoospermia. The correlation of testicular Doppler values with nitric oxide and testicular sperm extraction was further evaluated.Design: Prospective study.Setting: Assisted reproduction unit at a university center.Patient(s): Twenty-eight men with azoospermia undergoing sperm extraction for intracytoplasmic sperm injection.Intervention(s): Ultrasound and color Doppler scanning of the testes. Testicular sperm retrieval and nitrite/nitrate assay.Main Outcome Measure(s): Doppler analysis of testicular transmediastinal artery, plasma and seminal plasma nitrite/nitrate values, and sperm extraction histopathology.Result(s): The pulsatility index (PI) of the transmediastinal artery was higher in patients with nonobstructive azoospermia (PI = 1.40 ± 0.13) than in those with obstructive azoospermia (PI = 1.09 ± 0.15; P=.011). Seminal plasma nitrite/nitrate concentrations were more elevated in cases of obstructive azoospermia than in gonadal failure. Unsuccessful sperm recovery was observed in four patients who showed the worst indices of gonadal failure. In this subgroup, a transmediastinal PI value >1.50 was always observed.Conclusion(s): Doppler analysis of the transmediastinal artery and nitrite/nitrate seminal plasma concentrations are useful for distinguishing between obstructive and nonobstructive azoospermia and allow the identification of the presence of spermatozoa within the testes.
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to evaluate whether patients with partial bilateral polycystic ovaries show different ovarian and uterine blood flow to those with complete bilateral polycystic ovaries, and to investigate whether there is a correlation between ultrasonographic and hormonal parameters. Fifteen patients with partial polycystic ovaries and eighteen patients with complete bilateral polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation. Hormonal (luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessels pulsatility index, ovarian stromal vascularization) parameters were evaluated, in the early follicular phase (cycle day 3-5) in oligomenorrheic patients, or at random in amenorrheic patients. Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in complete bilateral polycystic ovaries. In partial polycystic ovaries, gray-scale and color Doppler ultrasonography showed different features in affected and unaffected areas of the ovary, similar to polycystic and normal ovary appearance respectively. In conclusion, PCOS does not predetermine a single ultrasonographic or Doppler pattern.
[Show abstract][Hide abstract]ABSTRACT: The objective of the present study was prospectively to evaluate the role of nitric oxide (NO) in modulating intratesticular
blood flow and sperm function. A total of 56 males, undergoing assisted reproduction, were divided into three groups according
to semen analysis: (i) normozoospermic (n = 16); (ii) oligozoospermic (n = 21); and (iii) azoospermic (n = 19). All the subjects were submitted to hormone analysis [luteinizing hormone, follicle stimulating hormone (FSH), growth
hormone, testosterone, androstenedione, insulin], and to ultrasonographic (testicular volume) and Doppler (transmediastinal
artery) evaluations. Plasma and seminal plasma nitrite/nitrate concentrations, and plasma insulin-like growth factor-I were
assayed. All 56 patients completed the study. In normozoospermic patients, significantly greater testicular volume, lower
transmediastinal resistances, and higher seminal plasma nitrite/nitrate concentrations were observed in comparison with both
oligo- and azoospermic subjects. Testicular volume was inversely correlated with plasma FSH (r = –0.589; P = 0.005) and pulsatility index of transmediastinal artery (r = –0.402; P = 0.049). Furthermore, the seminal plasma nitrite/nitrate concentrations were inversely correlated with pulsatility index
of transmediastinal artery (r = –0.511; P = 0.015). It was concluded that NO is involved in vascular modulation of testicular vessels and ultimately in sperm output.
Full-text available · Article · Jan 2001 · Human Reproduction
[Show abstract][Hide abstract]ABSTRACT: Objective: To prospectively evaluate follicular fluid levels of vascular endothelial growth factor in women undergoing IVF cycles and to investigate the correlation of these levels with ovarian response to gonadotropins and with uterine or ovarian Doppler findings.Design: Prospective study.Setting: University hospital.Patient(s): 41 patients undergoing ART were divided into two groups according to response to ovarian stimulation protocols: poor responders (n = 18) and normoresponders (n = 23).Intervention(s): Doppler analysis of perifollicular arteries and assay of follicular fluid vascular endothelial growth factor.Main Outcome Measure(s): During ovarian stimulation, patients underwent hormonal (E2), ultrasonographic (follicular number and diameter, endometrial thickness) and Doppler (uterine and perifollicular arteries) evaluation. Serum and follicular fluid concentrations of vascular endothelial growth factor were assayed in each female patient.Result(s): Compared with poor responders, more oocytes were collected and more embryos were transferred but follicular fluid levels of vascular endothelial growth factor levels were lower in normoresponders. Follicular fluid levels of vascular endothelial growth factor were inversely correlated with number of oocytes retrieved. Poor responders had significantly higher uterine and perifollicular Doppler flow resistances. The pregnancy rate per cycle was significantly higher in normoresponders (26%) than poor responders (6%).Conclusion(s): Elevated follicular fluid levels of vascular endothelial growth factor concentrations are associated with poor ovarian response and a very low pregnancy rate.
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to compare the costs and effects of two different controlled ovarian hyperstimulation treatments: a starting dose of recombinant follicle stimulating hormone (FSH) followed by highly purified urinary FSH; or highly purified urinary FSH alone. Forty-six infertile patients, after being given luteal gonadotropin-releasing hormone (GnRH) agonist, were randomly assigned to the two stimulation protocols. During the ovarian stimulation regimen the patients underwent transvaginal ultrasonographic evaluation of follicular number and size. The retrieved oocytes were classified on the basis of the criteria of Acosta and colleagues. To study the impact of embryo quality on implantation, the embryos were graded morphologically before replacement. Pregnancy rates were ascertained and the costs of the two different protocols were analyzed. The number of days of FSH stimulation and the cost of gonadotropin treatment were similar in both groups. The number of follicles > 17 mm in size, the number of collected oocytes, and pregnancy rate per cycle were significantly higher in the group partially treated with recombinant gonadotropin. We conclude from these results that the use of recombinant FSH in the early phase of controlled ovarian hyperstimulation leads to significant improvements in pregnancy rate per cycle without increasing the costs of treatment.
[Show abstract][Hide abstract]ABSTRACT: We report a case of general hypersensitivity-like allergic reactions to intramuscular injections of highly purified urinary follicle stimulating hormone (uFSH-HP) successfully managed by using intramuscular recombinant FSH (rFSH). The patient underwent a first cycle of in vitro fertilization (IVF) and controlled ovarian hyperstimulation (COH) was achieved with a combination of gonadotropin releasing hormone against (GnRH-a) and uFSH-HP. Because, after oocyte recovery, no fertilization occurred, the couple subsequently entered an intracytoplasmic sperm injection (ICSI) program. During the COH, the woman developed general hypersensitivity-like allergic reactions with itching, redness and swelling. Although there was regular follicular growth, the allergic symptoms worsened and, on day 8 of COH, the stimulation cycle was suspended. A few months later, the patient entered a new ICSI cycle. COH was achieved by using a combination of GnRH-a and rFSH. The cycle was completed and the patient did not report any allergic reaction. To avoid allergic reaction to the protein components of the urine-derived FSH preparations, the use of rFSH is suggested in those patients who present local and/or general hypersensitivity-like allergic reactions.