Pyridostigmine Co-Treatment during Controlled Ovarian Hyperstimulation in Low Responders

Kim, J H; Chae, H D; Kang, B M; Chang, Y S; Mok, J E

Abstract

The present study was performed to investigate whether pyridostigmine, acetylcholinesterase inhibitor, co-treatment during controlled ovarian hyperstimulation (COH) would improve the clinical outcome in low responders undergoing in vitro fertilization and embryo transfer (IVF-ET). From August 1995 to October 1997, 76 infertile women with previous history of poor response to COH in IVF-ET cycles were allocated randomly to the treatment group and the control group. The COH using luteal long protocol of GnRH agonist was used in all patients. The treatment group (n=38) were administered in daily oral dosage of pyridostigmine 120 mg from the first day of COH to the day of hCG administration. The patients with no treatment served as the control. The serum concentrations of GH and IGF-I were measured in all patients on the beginning day of COH, the 5th day of COH, and the day of hCG administration, respectively. The total dose and duration of exogenous gonadotropin required in the treatment group were significantly decreased than those of the control group (36.6+/-11.9 vs. 49.4+/-12.7, 9.5+/-1.8 vs. 10.4+/-2.1, respectively), and the concentration of estradiol (E2) on the day of hCG administration in the treatment group was significantly higher than in the control group (876.1+/-772.9 pg/ml vs. 562.8+/-460.2 pg/ml). The mean numbers of oocytes retrieved, oocytes fertilized, and oocytes cleaved of the treatment group were also significantly higher than those of the control group (5.9+/-3.8 vs. 4.2+/-2.7, 4.6+/-2.9 vs. 3.3+/-1.9, 4.1+/-2.3 vs. 2.8+/-2.1, respectively). There was tendency that the mean numbers of grade I, II embryos and embryos transferred were increased in the treatment group, despite of no statistical significance. The pregnancy rate seemed to be higher in the treatment group. However, there was no significant difference between the two groups (21.1% vs. 10.5%). In addition, the concentrations of serum GH and IGF-I measured on the 5th day of COH in the treatment group were significantly higher than those of the control group. In conclusion, it was suggested that pyridostigmine co-treatment during COH could improve the ovarian response and clinical outcome in low responders undergoing IVF-ET and this study would also contribute much to effective management of infertile couples.