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.

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(Plateau [2004, 2008], Smitz, Ziebe) and three studies were excluded because of insufficient details (Elwin [unpublished data], Loutradis, Strowitski) [1,2,13,18,23,26,30-32,42-45].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.…”

“…Westergaard compared hMG and r-hFSH using the same studies as Al-Inany, and added four other trials [18-22]. No differences were found for ongoing pregnancy or live birth per woman (OR 1.27; 95% CI: 0.98 to 1.64), however borderline significance was observed for some secondary outcomes in favour of both hMG and r-hFSH depending on the endpoint.…”

Recombinant human follicle-stimulating hormone (r-hFSH) plus recombinant luteinizing hormone versus r-hFSH alone for ovarian stimulation during assisted reproductive technology: systematic review and meta-analysis

“…The search results were cross-checked against publications listed in previous meta-analyses [15-19] to ensure that all relevant studies were included.…”

Lutropin alpha, recombinant human luteinizing hormone, for the stimulation of follicular development in profoundly LH-deficient hypogonadotropic hypogonadal women: a review

“…Multiple studies have been done to prove the superiority of a distinct gonadotropin preparation, with very conflicting results. 85,[87][88][89][90][91][92] These differences can be traced back, at least partly, to the incomplete downregulation through the GnRH agonists or antagonists, where secretion of LH continues to be detectable 93,94 in varing amounts. 95 No doubt has been raised about the necessity of a distinct amount of LH to ensure the resumption of meiosis, 96 the most crucial process to achieve full chromosomal integrity and oocyte diploidy.…”