Ovarian stimulation with r-hFSH:r-hLH: a descriptive analysis of embryonic morphokinetic data

The objective of this study was to compare embryonic morphokinetic parameters and clinical outcomes of two controlled ovarian stimulation (COS) protocols in women of advanced maternal age (AMA): Pergoveris (r-hFSH:r-hLH, 2:1 ratio) versus r-hFSH monotherapy (GONAL-f). This retrospective, non-interventional descriptive study was conducted at a private university-affiliated IVF center and included 136 ICSI cycles performed in AMA patients between March 2019 and May 2020. Patients were grouped by COS protocol (GONAL-f, n = 64; Pergoveris, n = 72), and embryo morphokinetics and ICSI outcomes were extracted from the clinic's database; the main outcome was time to complete blastulation (tB, hours). Embryos from the Pergoveris group reached tB earlier than those from the GONAL-f group (mean 109.3 h vs 112.6 h), and all morphokinetic milestones occurred sooner with Pergoveris, alongside lower multinucleation rates at the 2-cell and 4-cell stages. Although blastocyst development was higher in the GONAL-f group, Pergoveris was associated with higher oocyte yield and maturity, higher implantation, clinical and ongoing pregnancy rates, and lower miscarriage and OHSS rates; Pergoveris cycles also required higher gonadotropin doses and longer stimulation. Overall, embryos from the r-hFSH:r-hLH group exhibited faster morphokinetic timings and improved implantation and pregnancy outcomes, and prospective studies are warranted to confirm these observations.