Human menopausal gonadotropin versus recombinant follicle stimulation hormone for ovarian stimulation in assisted reproductive cycles

Abstract

For all three GnRHa protocols analysed there is insufficient evidence of a difference between hMG and rFSH on ongoing pregnancy or live birth. More large randomised trials are needed to estimate the difference between hMG and rFSH more precisely. Such trials should preferably (1) use a consistent long GnRHa protocol and (2) use a fixed dose of gonadotrophin such to prevent potentially subjective decisions of the clinician in dosing and (3) take live birth as primary endpoint. At this moment in time however, in prescribing gonadotrophins for ovarian hyperstimulation in IVF one should use the least expensive medication.

Infertility Management and Pharmacotherapy: What Every Pharmacist Should Know

“…Numerous studies and meta-analysis have evaluated production of oocytes, pregnancy rates, and OHSS in patients receiving hMG compared to recombinant FSH (r-FSH) in IVF cycles. 49 -52 Pregnancy and OHSS rates were similar between the groups. The current data do not prove the superiority of r-FSH over hMG, and current practices should be individualized based on clinic protocols and potential cost of medication.…”

Infertility Management and Pharmacotherapy: What Every Pharmacist Should Know

“…Numerous studies and meta-analysis have evaluated production of oocytes, pregnancy rates, and OHSS in patients receiving hMG compared to recombinant FSH (r-FSH) in IVF cycles. 49 -52 Pregnancy and OHSS rates were similar between the groups. The current data do not prove the superiority of r-FSH over hMG, and current practices should be individualized based on clinic protocols and potential cost of medication.…”

Recombinant human follicle-stimulating hormone produces more oocytes with a lower total dose per cycle in assisted reproductive technologies compared with highly purified human menopausal gonadotrophin: a meta-analysis

“…From 30 publications comparing r-hFSH versus hMG in ART, seven were meta-analyses/reviews (Al-Inany [2003, 2005, 2008, 2009], Westergaard, Coomarasamy, Afnan), four were excluded as duplicate publications (Plateau [2004, 2008], Smitz, Ziebe) and three studies were excluded because of insufficient details (Elwin [unpublished data], Loutradis, Strowitski) [1,2,13,18,23,26,30-32,42-45]. The 16 remaining studies which were truly or quasi-randomized met the inclusion criteria and were found to be of acceptable internal validity [5,14-17,19-22,24,25,27-29,46,47].…”

“…Combined with sensitivity analyses, our method of trial selection provided a robust number of studies (n = 16) compared to prior meta-analyses which included between 4 and 12 studies comparing hMG and r-hFSH [13,18,23,26,30,31]. As a result of the large sample size of this meta-analysis, and the fact that several endpoints were considered, the level of significance was set at P < 0.01.…”

Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques: a retrospective study

“…There could be a concern regarding the need to transfer frozen embryos in a subsequent cycle due to the detrimental impact of early endometrial exposure to progesterone. However, we did not consider this a limiting factor, because the evolution of cryopreservation techniques has led to comparable results for frozen embryo cycles and fresh ET (Massin, 2017;Reichman et al, 2014;Roque, 2015;Shapiro et al, 2009;Van Wely et al, 2003). The freeze-all strategy also enables the embryos to be transferred into a more physiological uterine environment (Wang et al, 2016).…”

Infertility Management and Pharmacotherapy: What Every Pharmacist Should Know

“…Numerous studies and meta-analysis have evaluated production of oocytes, pregnancy rates, and OHSS in patients receiving hMG compared to recombinant FSH (r-FSH) in IVF cycles. 49 -52 Pregnancy and OHSS rates were similar between the groups. The current data do not prove the superiority of r-FSH over hMG, and current practices should be individualized based on clinic protocols and potential cost of medication.…”

Recombinant human follicle-stimulating hormone produces more oocytes with a lower total dose per cycle in assisted reproductive technologies compared with highly purified human menopausal gonadotrophin: a meta-analysis

“…From 30 publications comparing r-hFSH versus hMG in ART, seven were meta-analyses/reviews (Al-Inany [2003, 2005, 2008, 2009], Westergaard, Coomarasamy, Afnan), four were excluded as duplicate publications (Plateau [2004, 2008], Smitz, Ziebe) and three studies were excluded because of insufficient details (Elwin [unpublished data], Loutradis, Strowitski) [1,2,13,18,23,26,30-32,42-45]. The 16 remaining studies which were truly or quasi-randomized met the inclusion criteria and were found to be of acceptable internal validity [5,14-17,19-22,24,25,27-29,46,47].…”

“…Combined with sensitivity analyses, our method of trial selection provided a robust number of studies (n = 16) compared to prior meta-analyses which included between 4 and 12 studies comparing hMG and r-hFSH [13,18,23,26,30,31]. As a result of the large sample size of this meta-analysis, and the fact that several endpoints were considered, the level of significance was set at P < 0.01.…”

Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques: a retrospective study

“…There could be a concern regarding the need to transfer frozen embryos in a subsequent cycle due to the detrimental impact of early endometrial exposure to progesterone. However, we did not consider this a limiting factor, because the evolution of cryopreservation techniques has led to comparable results for frozen embryo cycles and fresh ET (Massin, 2017;Reichman et al, 2014;Roque, 2015;Shapiro et al, 2009;Van Wely et al, 2003). The freeze-all strategy also enables the embryos to be transferred into a more physiological uterine environment (Wang et al, 2016).…”

Infertility Management and Pharmacotherapy: What Every Pharmacist Should Know

“…Numerous studies and meta-analysis have evaluated production of oocytes, pregnancy rates, and OHSS in patients receiving hMG compared to recombinant FSH (r-FSH) in IVF cycles. 49 -52 Pregnancy and OHSS rates were similar between the groups. The current data do not prove the superiority of r-FSH over hMG, and current practices should be individualized based on clinic protocols and potential cost of medication.…”

Recombinant human follicle-stimulating hormone produces more oocytes with a lower total dose per cycle in assisted reproductive technologies compared with highly purified human menopausal gonadotrophin: a meta-analysis

“…From 30 publications comparing r-hFSH versus hMG in ART, seven were meta-analyses/reviews (Al-Inany [2003, 2005, 2008, 2009], Westergaard, Coomarasamy, Afnan), four were excluded as duplicate publications (Plateau [2004, 2008], Smitz, Ziebe) and three studies were excluded because of insufficient details (Elwin [unpublished data], Loutradis, Strowitski) [1,2,13,18,23,26,30-32,42-45]. The 16 remaining studies which were truly or quasi-randomized met the inclusion criteria and were found to be of acceptable internal validity [5,14-17,19-22,24,25,27-29,46,47].…”

“…Combined with sensitivity analyses, our method of trial selection provided a robust number of studies (n = 16) compared to prior meta-analyses which included between 4 and 12 studies comparing hMG and r-hFSH [13,18,23,26,30,31]. As a result of the large sample size of this meta-analysis, and the fact that several endpoints were considered, the level of significance was set at P < 0.01.…”

Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques: a retrospective study

“…There could be a concern regarding the need to transfer frozen embryos in a subsequent cycle due to the detrimental impact of early endometrial exposure to progesterone. However, we did not consider this a limiting factor, because the evolution of cryopreservation techniques has led to comparable results for frozen embryo cycles and fresh ET (Massin, 2017;Reichman et al, 2014;Roque, 2015;Shapiro et al, 2009;Van Wely et al, 2003). The freeze-all strategy also enables the embryos to be transferred into a more physiological uterine environment (Wang et al, 2016).…”