Clinical outcomes following long GnRHa ovarian stimulation with highly purified human menopausal gonadotropin plus rFSH or rFSH in patients undergoing in vitro fertilization-embryo transfer: a multi-center randomized controlled trial

Abstract

Background: This clinical trial aimed to compare the clinical efficacy of highly purified human menopausal gonadotropin (HP-HMG) plus recombinant human follicle-stimulating hormone (rFSH) versus rFSH alone on controlled ovarian stimulation (COS) in vitro fertilization-embryo transfer (IVF-ET).Methods: A total of 610 women underwent long gonadotropin-releasing hormone (GnRH) agonist protocol for IVF treatment. The subjects were randomized into 2 groups: HP-HMG + rFSH group (n=305) and rFSH group (n=305). The main outcome was the progesterone (P) level on the day of HCG injection.Results: There was no significant difference in terms of the demographic and baseline characters between the two groups. In rFSH group, the P level on the day of HCG trigger were significantly higher than that of HP-HMG+rFSH group (4.3±2.2 vs. 3.8±1.7 nmol/L, P<0.001). The fertilization rate in rFSH group was significantly lower than that of HP-HMG + rFSH group (69.2% vs. 73.9%, P<0.001). Simultaneously, the percentage of cycles with fresh embryo transfer in rFSH group was also significantly lower than that of HP-HMG + rFSH group (49.6% vs. 57.5%, P=0.007). However, there was no difference in terms of cleavage rate, implantation rate, clinical pregnancy rate and ovarian hyperstimulation syndrome (OHSS) rate between two groups.Conclusions: The use of combined HP-HMG with FSH may be superior to rFSH alone in stimulating the ovary in normal responders undergoing IVF treatment. Furthermore, the further prospective studies with large sample are still needed to confirm the study.

Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques

“…The discrepancy in the outcomes between the two protocols (GnRH agonist and GnRH antagonist) was attributed by the authors to the difference in the mechanism of each analog indicating the potential beneficial effect on the use of HMG in GnRH antagonist protocols in selected patients where mild stimulation is expected [15]. A recently published RCT that compared the efficacy of COS with highly purified (HP)-HMG plus rFSH versus rFSH alone in long GnRH agonist protocols showed that although the rFSH group was found with significantly increased retrieved oocytes, fertilization rates were higher in the HMG group whereas implantation and pregnancy rates were not different among the two groups [7]. Another systematic review by Levi Setti et al that presented the outcomes of studies comparing the administration of rFSH with HMG during COS observed that in the majority of included studies (10 out of 13), the number of retrieved oocytes was significantly higher in the rFSH group and the cost for both therapies was comparable [25].…”

“…Selection of the most appropriate regimen among uFSH and rFSH still remains challenging with the currently available literature reporting no significant differences in the number of oocytes retrieved or pregnancy rates among the two types of FSH [5,6]. The aforementioned gonadotropin preparations have been administered to support COS in infertile women who undergo ART protocols [7]. Hence, no consensus is available on the optimal regimens and preparations [7].…”

“…The aforementioned gonadotropin preparations have been administered to support COS in infertile women who undergo ART protocols [7]. Hence, no consensus is available on the optimal regimens and preparations [7]. Several studies support the addition of the activity of LH-related regimens to FSH in COS. LH, hCG, and HMG and various combinations of them have been administered with or without FSH for COS [5].…”

Intracytoplasmic sperm injection outcomes in patients with orgasmic dysfunction and anejaculation by percutaneous epididymal sperm aspiration (PESA)

“…Fresh embryo freezing or transfer was performed 3 or 5 days after fertilization. Whole embryo cryopreservation was carried out when the risk of ovarian hyperstimulation was high, and when the endometrium (thickness <7 mm) was not suitable for transplantation (13). Routine progesterone was given, and β-hCG was tested 2 weeks later to assess the pregnancy outcome.…”

DNA methylation status of imprinted H19 and KvDMR1 genes in human placentas after conception using assisted reproductive technology

“…ARTs are generally considered to be relatively safe; however, ARTs have been suggested to disturb epigenetic (re)programming during gamete and embryo development, which could have potentially adverse consequences on the epigenetic composition of the embryo (5)(6)(7). Recent studies have shown that ART may increase the risk of congenital disabilities, genetic imprinting disorders, and some childhood tumors (8)(9)(10).…”