In a nutshell
This study compared human menopausal gonadotropin (hMG) to follicle-stimulating hormone (FSH) prior to intracytoplasmic sperm injection (ICSI) for patients predicted to have a strong ovarian response. It found that both types of gonadotropin hormone were effective, but that hMG had fewer side effects and miscarriages.
ICSI is an infertility treatment that involves collecting oocytes (eggs), injecting each oocyte with a single sperm, and implanting a fertilized embryo(s) in the uterus.
The first step of ICSI is to use medications for ovarian stimulation (OS). One type of medication used for OS is gonadotropin hormones. Gonadotropins directly stimulate ovarian follicles to develop. hMG and FSH are two gonadotropins used for OS.
Not all women respond the same way to OS. Women who produce many follicles in response to OS are said to be high responders. Blood tests of hormone levels can predict which patients will be high responders. High responders are more likely to have a successful treatment, but they are also at higher risk of ovarian hyperstimulation syndrome (OHSS). OHSS occurs when the ovaries respond too vigorously to OS. OHSS causes symptoms including weight gain and abdominal pain and has a risk of serious complications that require hospital treatment.
It is unclear whether hMG or FSH is a better gonadotropin hormone for predicted high responders.
Methods & findings
This study included 620 patients undergoing ICSI who were predicted to be high responders to OS. Half of the patients randomly received hMG (Menopur), and half received recombinant FSH (Gonal-f). The researchers compared how many patients in each group had a pregnancy confirmed by ultrasound after a fresh embryo transfer.
There was a trend toward more pregnancies in the hMG group (35.5% vs. 30.7%). The live birth rates after fresh transfer were 52.2% for hMG and 48.7% for FSH. After a frozen transfer, the birth rates were 63.4% for the hMG group and 50.8% for the FSH group.
Patients treated with hMG had significantly fewer miscarriages (14.5% vs. 25.5%). Patients treated with hMG also had a lower rate of side effects (57.7% vs. 70.6%). The rate of OHSS was significantly lower for patients treated with hMG (9.7% vs. 21.4%). Three patients (1.0%) treated with hMG had severe OHSS, compared to seven (2.3%) treated with FSH.
The bottom line
This study found that hMG was as effective as FSH for high ovarian responders, and led to a lower rate of side effects including OHSS.
Published By :
Fertility and Sterility
May 13, 2020