Comparison of FSH and hMG on ovarian stimulation outcome with a GnRH antagonist protocol in younger and advanced reprodu
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ORIGINAL ARTICLE
Comparison of FSH and hMG on ovarian stimulation outcome with a GnRH antagonist protocol in younger and advanced reproductive age women Chisa Tabata • Toshihiro Fujiwara • Miki Sugawa • Momo Noma • Hiroki Onoue • Maki Kusumi • Noriko Watanabe • Takako Kurosawa • Osamu Tsutsumi
Received: 5 May 2014 / Accepted: 14 June 2014 Ó Japan Society for Reproductive Medicine 2014
Abstract Purpose To compare the embryo outcomes of in vitro fertilization/intra-cytoplasmic sperm injection with a gonadotropin-releasing hormone (GnRH) antagonist protocol with follicle stimulating hormone (FSH) and with human menopausal gonadotropin (hMG). Methods We performed a retrospective cohort study in 465 patients. Stimulation was started by daily FSH injection, and either FSH was continued (FSH alone group) or hMG was administrated (FSH-hMG group) after administration of a GnRH antagonist. Primary outcomes were the embryo profile (number of retrieved, mature, and fertilized eggs, and morphologically good embryos on day 3) and endocrine profile. Secondary outcomes were the doses and durations of gonadotropin. Data were stratified by the patients’ age into two groups: \35 years and C35 years. Results In patients aged \35 years, the number of retrieved oocytes in the FSH alone group was significantly increased than that in the FSH-hMG group (13.7 vs 9.2, P = 0.04), while there was no difference at other age groups. The FSH-hMG group required a significantly greater amount of gonadotropins at any age (all ages, P \ 0.001; \35 years, P = 0.013; C35 years, P \ 0.001). Conclusions Exogenous FSH alone is probably sufficient for follicular development and hMG may not improve the embryo profile in a GnRH antagonist protocol across all age.
C. Tabata (&) T. Fujiwara M. Sugawa M. Noma H. Onoue M. Kusumi N. Watanabe T. Kurosawa O. Tsutsumi Sanno Hospital, Center of Reproduction and Gynecologic Endoscopic Surgery, 8-10-16 Akasaka Minatoku, Tokyo, Japan e-mail: [email protected]
Keywords Embryo profile Endocrine profile FSH GnRH Antagonist hMG
Introduction In controlled ovarian stimulation (COS) of assisted reproductive technology (ART), FSH is essential but significance of luteinizing hormone (LH) supplementation is controversial. Recent meta-analyses have shown that human menopausal gonadotropin (hMG) leads to higher pregnancy rates than recombinant follicle stimulating hormone (rFSH) in a long gonadotropin-releasing hormone (GnRH) agonist protocol [1–3]. The GnRH antagonist protocol is widely used, as well as the GnRH agonist protocol for COS for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). However, whether supplementation of LH is beneficial in this protocol is unclear. A few randomized controlled trials (RCT) reported that highly purified hMG (hp-hMG) and rFSH showed similar outcomes, such as the pregnancy rate, the pregnancy loss rate, and the live birth rate [4, 5]. In contrast, the inhibitory effect of GnRH antagonists on LH secretion and a lower pregnancy rate has been show
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