Adding human menopausal gonadotrophin to antagonist protocols - is there a benefit?

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Gonadotropins are crucial for controlled ovarian stimulation in IVF.
• Recombinant FSH (r-FSH) and human menopausal gonadotropin (HMG) are commonly used, but their comparative efficacy in specific protocols is debated.

Purpose of the Study:

• To compare clinical outcomes of r-FSH monotherapy versus a combination of r-FSH and HMG in patients undergoing IVF.
• To evaluate the efficacy of these protocols within a standard gonadotrophin-releasing hormone (GnRH) antagonist regimen.

Main Methods:

• Retrospective analysis of IVF cycles from 2001-2003 in a private practice.
• Patients received either r-FSH or a combination of r-FSH and HMG for ovarian stimulation.
• Standard GnRH antagonist protocol used, with ovulation triggered by recombinant or urinary hCG.

Main Results:

• The r-FSH alone group showed fewer cancelled cycles and a higher number of oocytes retrieved, mature oocytes, fertilized oocytes, and cleaved embryos.
• A trend towards higher clinical pregnancy rates was observed with r-FSH monotherapy.
• While the r-FSH plus HMG group had lower miscarriage rates, live birth rates were similar between groups.

Conclusions:

• Combination therapy with HMG plus r-FSH did not offer additional benefits over r-FSH alone in patients using a GnRH antagonist protocol.
• r-FSH monotherapy appears to be a viable and potentially more effective strategy for ovarian stimulation in this patient population.