July 18, 2014

expert reaction to kisspeptin and ovarian stimulation

Research in the Journal of Clinical Investigation reported that kisspeptin can be used to trigger ovulation after ovarian stimulation in IVF, and that the substance may reduce ovarian hyper stimulation; a serious complication of IVF associated with use of an alternative hormone.

Professor David Adamson, Board Member of the International Federation of Fertility Societies, said:

“This is an interesting study that identifies an additional new drug that could potentially make IVF, an already safe procedure, even safer from one of its side effects, ovarian hyperstimulation syndrome (OHSS). Other effective strategies to prevent OHSS are already in clinical practice, and the new drug would have to go through large clinical trials to confirm its efficacy, safety and equivalence to these other medications currently in use. Nevertheless, more research such as was performed in this study that increases effectiveness and safety of IVF treatment will bring benefit to the millions of women and men who suffer from infertility.”

Dr Mark Hamilton, Honorary Senior Lecturer & Consultant Gynaecologist, University of Aberdeen, said:

“IVF has transformed the lives of thousands of infertile men and women in the UK. The treatment is not without risk and severe ovarian hyper stimulation syndrome (OHSS) is an unpleasant and sometimes dangerous complication which fortunately occurs only rarely. Stimulation of the ovaries is a necessary part of an IVF cycle and clinics have a number of drug regimens to choose from to minimise the risk of women developing OHSS.

“This new drug may provide clinics with another option to minimise risks for women having IVF and the birth of babies using the new medication is very exciting. Larger clinical trials will eventually tell us whether success rates i.e. live birth rates with this drug match those with drug protocols currently in use but the initial results are very promising.”

Prof Alison Murdoch, Head of Newcastle Fertility Centre at Life, Newcastle University, said:

“Kisspeptin may be useful to prevent ovarian hyper stimulation syndrome (OHSS) but this study doesn’t address this problem. Mild OHSS is unpleasant but the severe form that worries us only affects about 2% of women having IVF so this study is not big enough.”

Dr Yakoub Khalaf, Director of the Assisted Conception Unit & Centre for Pre-implantation Genetic Diagnosis, King’s College London, said:

“This is an interesting study. It demonstrates that kisspeptin can be used to trigger ovulation after ovarian stimulation in IVF and that the authors speculate that it can reduce one of the serious complications of IVF; ovarian hyper stimulation.

“Whilst it is plausible that the risk of hyper stimulation syndrome could be reduced following use of kisspeptin, the number of patients studied is too small to demonstrate reduction in the incidence of of a condition that occurs, in a clinically significant form, in 3-5 % of IVF patients. A much much larger number would be needed to demonstrate a significant difference. More importantly no information is presented on whether the pregnancy rates after using this product would be similar to the conventional methods < 25% (12/49) pregnancy rate is hardly a resounding endorsement for effectiveness of this product. Additionally, currently OHSS can be virtually eliminated by using a product that has been available for decades to trigger ovulation (called decapeptyl or buserelin).

“So the bottom line is an interesting product but more clinical data is needed to demonstrate that kisspeptin is not just safe but also does not reduce the chance of a pregnancy.”

‘Kisspeptin-54 triggers egg maturation in women undergoing in vitro fertilisation’ by C.N. Jayasena et al. published in the Journal of Clinical Investigation on Friday 18 July 2014.