The impact of adding hp-hMG in r-FSH started GnRH antagonist cycles on ART outcome

Abstract

While luteinizing hormone (LH) activity is believed to play a role in follicle maturation, human chorionic gonadotropin (hCG) might play an important role in implantation process. We aimed to investigate whether addition of human menopausal gonadotropin (hMG) in recombinant-follicle-stimulating hormone (r-FSH) started GnRH antagonist controlled ovarian hyperstimulation (COH) cycles might enhance implantation rate and improve in vitro fertilization (IVF) success. A total of 246 patients undergoing GnRH antagonist IVF cycles were analyzed. One hundred and twenty-three cycles (%50) were treated with only r-FSH and 123 cycles were treated with r-FSH plus hp-hMG combination. Total gonadotropin doses, total number of oocytes retrieved, metaphase 2 (MII) oocytes, top quality embryos, fertilization and implantation rates, clinical pregnancy rates (CPRs) and ovarian hyperstimulation syndrome (OHSS) rates were compared between the groups. Both groups were comparable in terms of demographic details and baseline characteristics. Peak estradiol and progesterone levels in hCG trigger day, number of retrieved oocytes and top quality embryo counts, fertilization rates were similar between the groups. In r-FSH + hp-hMG group, significantly higher implantation rates (35.3% vs 24.3%, p=.017), CPRs (51.2% vs 35.8%, p=.015) and lower OHSS rates (1.6% vs 7.4%, p = .03) were observed respectively compared to r-FSH only treated patients. In conclusion, addition of hp-hMG on the day of antagonist initiation might increase CPRs. A better endometrial receptivity associated with higher implantation rates might be achieved due to hCG component in hp-hMG.

摘要

普遍认为黄体生成素（LH）活性在卵泡成熟中起作用, 而人绒毛膜促性腺激素（hCG）可能在植入过程中起重要作用。我们的目的是研究在重组卵泡刺激素（r-FSH）启动的GnRH拮抗剂卵巢控制性超促排卵（COH）周期中添加人绝经期促性腺激素（hMG）是否能提高植入率并改善体外受精（IVF）的结局。共分析了246名接受GnRH拮抗剂IVF周期的患者。仅用r-FSH处理123个周期（％50）, 用r-FSH加hp-hMG组合处理123个周期。比较各组之间的总促性腺激素剂量, 获卵母细胞总数, 第2次减数分裂中期（MII）卵母细胞, 优质胚胎, 受精和植入率, 临床妊娠率（CPR）和卵巢过度刺激综合征（OHSS）发生率。两组患者在人口学资料和基线特征方面具有可比性。hCG扳机日的雌二醇和孕酮水平峰值, 获卵母细胞数和最高质量的胚胎计数, 受精率在各组之间无统计学差异。与仅经r-FSH治疗的患者相比, r-FSH+hp-hMG组患者植入率（35.3％ vs 24.3％, p = .017）, CPR（51.2％ vs 35.8％, p = .015）显着更高, OHSS发生率较低（1.6％ vs 7.4％, p =.03）。总之, 在拮抗剂方案启动当天加入hp-hMG可能会增加临床妊娠率。hp-hMG中的hCG成分, 可以提高子宫内膜容受性, 从而提高植入率。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• rFSH
• hp-HMG
• antagonist
• IVF

Acknowledgments

This study was presented at 63rd Annual Scientific Meeting of Society of Reproductive Investigation: Abstract # 700012. We would like to thank the members of Ankara University IVF Center for their contributions of the described work.

Disclosure statement

No potential conflict of interest was reported by the authors.