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Recombinant versus urinary human chorionic gonadotrophin for ovulation induction in assisted conception
H G Al-Inany1, M Aboulghar, R Mansour
1Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, 8 Moustapha Hassanin St, Manial, Cairo, Egypt. kaainih@link.net
The Cochrane Database of Systematic Reviews
|April 23, 2005
Summary
Recombinant gonadotrophins, including recombinant hCG (rhCG) and recombinant LH (rLH), show similar clinical outcomes to urinary hCG for ovulation induction. rhCG offers reduced local site reactions compared to urinary hCG.
Area of Science:
- Reproductive Endocrinology
- Assisted Reproductive Technology
- Pharmacology
Background:
- Urinary human chorionic gonadotrophin (uhCG) has been the standard for inducing final follicular maturation and ovulation in assisted conception for decades.
- Recombinant technology has enabled the development of rhCG and rLH, offering potential advantages like adjusted commercial production and removal of urinary contaminants.
- Subcutaneous administration of recombinant gonadotrophins may offer improved safety and reduced batch-to-batch variation compared to intramuscular uhCG.
Purpose of the Study:
- To compare the safety and efficacy of subcutaneous recombinant hCG (rhCG) and high-dose recombinant LH (rLH) against intramuscular urinary hCG (uhCG).
- To evaluate their effectiveness in inducing final oocyte maturation and triggering ovulation in assisted conception.
Main Methods:
- A systematic search of major databases (Cochrane, MEDLINE, EMBASE) and trial bibliographies was conducted.
- Included were randomized controlled trials comparing rhCG or rLH with uhCG for ovulation induction in infertile women.
- Data extraction and quality assessment were performed independently by at least two reviewers.
Main Results:
- Seven RCTs were identified (4 rhCG vs uhCG, 3 rLH vs uhCG).
- No statistically significant differences in ongoing pregnancy/live birth rates, pregnancy rates, miscarriage, or OHSS incidence were found between rhCG/rLH and uhCG.
- rhCG was associated with a significant reduction in local site reactions and minor adverse effects.
Conclusions:
- Clinical outcomes for ovulation induction are comparable between urinary and recombinant gonadotrophins.
- Factors such as safety, cost, and availability should guide the choice of gonadotrophin.
- The manufacturer has discontinued the development of rLH.