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7 protocols using recombinant fsh

1

Standardized IVF/ICSI-ET Procedure

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IVF/ICSI-ET was performed according to the routine procedure of our center (11 (link)). Gonadotropins (Gn) including recombinant FSH (Merck Serono, Switzerland), urogenic FSH (Institut biochimique SA, Switzerland) and urogenic human Menopausal Gonadotropin (hMG) (Lizhu Pharmaceutical Co., Zhuhai) were initiated on the second day of menstruation bleeding. After 4-5 days injection of Gn, the serum levels of LH, E2, and progesterone were tested, and the growth of follicles were checked by vaginal B-ultrasound. Human chorionic gonadotropin (r-hCG, Adze, 250ug) was applied that night, when three follicles ≥ 18mm (follicles ≥ 17mm for the antagonist regimen) were detected. With the guidance of transvaginal ultrasound, oocytes retrieval was performed 36-38h later. Luteal support and 9% vaginal progesterone gel (Swiss Merck Serono) were given to all patients. For the fresh cycle transfer, one or two embryos would be transferred 3/5 days after the oocyte retrieval if the patient was available, and the remaining embryos were cryopreserved. For the frozen cycle transfer, the endometrial preparation was carried out according to the diagnosis and treatment routine of our center (11 (link)). After the endometrial thickness of 8 mm monitored by ultrasound, progesterone 40 mg/day and vaginal progesterone gel 90 mg/day were performed which was set as D0. The embryo was transferred on D3/D5.
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2

Controlled Ovarian Stimulation Protocol

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Pituitary down-regulation was carried out by a follicular phase long-acting GnRH-agonist long protocol. Before ovarian stimulation, all patients received a long-acting GnRH-a (Triptorelin acetate) at a dose of 3.75mg intramuscularly on the day 2-3 of menstruation. After 28 days, ovarian stimulation was initiated if FSH, LH and E2 levels, follicle diameter, and number met the downregulation criteria according to ultrasound and sex hormone examination. The initial dosage of gonadotropin (recombinant FSH, Merck Serono) was 75-300 IU/d as per basal hormone levels, BMI, antral follicle counts and age. The dosage could be adjusted after monitoring follicle growth and endometrial thickness with transvaginal ultrasound and determining serum E2 levels. When the most prominent two follicles reached 17 mm, 10000 IU recombinant-hCG (Serono, Switzerland) was administered intramuscularly for triggering oocyte maturation. We retrieved oocytes approximately 35-37h following triggering by transvaginal ultrasound aspiration, followed by IVF/ICSI as previously described (24 (link), 25 (link)).
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3

Personalized IVF Protocol for Infertility

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Based on clinical data such as infertility cause, age, follicle-stimulating hormone (FSH) levels, and antral follicle count (AFC), patients were selected for a personalized in vitro fertilization (IVF) protocal. The main use of follicular phase long acting gonadotrophin releasing hormone (GnRH) inhibitor protocal and GnRH antagonist protocal. After ovarian stimulation with gonadotropin -releasing hormone agonist (Serono, Geneva, Switzerlang) and recombinant FSH (Serono, Geneva, Switzerlang). Three or more follicles reached 17 mm diameter, and then 6000–10000 IU of human chorinic gonadotropin (hCG, Lizhu Inc., Zhuhai, China) was then administered to trigger final maturation. Oocytes were retrieved from under transvaginal ultrasonography-guided follicular aspiration was performed approximately 36 h after the hCG injection.
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4

ICSI-ET Protocol for Infertile Women

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CCs were isolated from the infertile women who were treated with ICSI-ET at the Reproductive Medicine Center of the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. This study was approved by the Medical Ethical Committee of the hospital. Written informed consent was obtained from all couples participating in this study.
The long downregulation protocol was adopted for all the patients. All women were downregulated with a GnRH agonist on mid-luteal phase. When optimally downregulated, recombinant FSH (Merck Serono, Switzerland) was started on day 3 of the menstrual cycle. When one follicle size reached 18 mm or two follicles size reached 17 mm or three follicles size reached 16 mm, human chorionic gonadotropin (hCG, Merck Serono, Switzerland) was administered. At 36 hrs after administration of hCG, the follicles were aspirated through transvaginal ultrasound retrieval.
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5

Oocyte In Vitro Maturation Protocol

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After warming, GV oocytes were matured in maturation medium for 18 h. Maturation medium was composed of 75 mIU/ml recombinant FSH, 0.5 IU/ml hCG (Serono, Geneva, Switzerland), 1% ITS (Sigma), 10 ng/ml recombinant epidermal growth factor (Sigma), and 10% FBS in TCM-199 medium.
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6

Follicular Fluid and Cumulus Cells Analysis

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After ovarian stimulation with agonadotropin-releasing hormone agonist (Serono, Geneva, Switzerland) and recombinant FSH (Serono, Geneva, Switzerland), three or more follicles reached 17mmin diameter, and then 6000–10,000 IU of human chorionic gonadotropin (hCG, LizhuInc., Zhuhai, China) was administered. COCs were then retrieved from aspirated follicles 36 h after the hCG trigger. Follicular fluid was obtained from the first aspirated follicles and centrifuged at 450 g for 5 min; the clear supernatant was then stored at − 80 °C for subsequent NGF assessment. CCs were collected from 9 non-PCOS patients and 5 PCOS patients who received ICSI-embryo transfer, but not IVF-embryo transfer treatment as CCs from such patients would be contaminated with human sperm.
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7

Recombinant FSH Signaling in Cell Lines

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Recombinant FSH was purchased from Merck-Serono (Gonal F-75, Merck-Serono, France). Dulbecco's Modified Eagle Medium (DMEM), Ham F12 medium, trypsin, FCS (fetal calf serum), pcDNA3.1 Directional TOPO expression kit, Geneticin, Lipofectamine2000, ECL staining kit and Hybond-ECL nitrocellulose membrane were purchased from Life Technologies SAS. Δ 4-Androstenedione ] (AS 26.3 Ci/mmol) was purchased from Perkin Elmer. [3H] cAMP Assay Kit (TRK432) was purchased from GE Healthcare (Vélizy-Villacoublay, France). Antityrosine-tubulin antibody, kanamycin, penicillin, peptidase A, streptomycin and mouse anti-tyrosine-tubulin (TUBA) were purchased from Sigma-Aldrich. FSHR (N-20) antibodies, HRP-, TR-and FITC-conjugated secondary antibodies were from Santa Cruz Biotechnology and monoclonal mouse anti-actin (Ab-1) from Millipore SAS. Cell cycle analysis was performed using Coulter DNA-Prep Reagents kit (Beckman Coulter, France). M-MLV-RT, random primers, dNTPs, RNasin, Taq DNA polymerase, GoTaq qPCR Master Mix were purchased from Promega.
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