A comparative study of rFSH, HMG, and FSH-HMG stimulation protocols on embryo quality and outcomes across first and second IVF-ICSI cycles
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254364Keywords:
Human menopausal gonadotropin, Ovarian stimulation, Recombinant FSHAbstract
Background: Optimization of ovarian stimulation is crucial for improving oocyte quality, embryo development, and implantation outcomes in IVF/ICSI cycles. This study compared clinical and embryological results of three stimulation regimens recombinant FSH (rFSH), human menopausal gonadotropin (HMG), and a combined rFSH-HMG protocol-across two consecutive IVF/ICSI cycles to evaluate potential improvements over time.
Methods: A retrospective analysis was conducted on 120 women who underwent two IVF/ICSI cycles between 2021 and 2024. Participants were grouped into rFSH (n=67), HMG (n=33), and rFSH-HMG (n=13). Stimulation characteristics and embryological outcomes, including oocyte retrieval, MII oocyte yield, fertilization, and blastocyst formation, were compared between cycles. Statistical analysis included t-tests, chi-square tests, Mann-Whitney U tests, and ROC curve analysis to determine predictive value for fertilization and blastocyst development.
Results: Baseline demographics and hormonal parameters showed no significant differences between groups. In the second cycle, the rFSH group demonstrated significantly higher oocyte retrieval, MII oocyte yield, fertilization, and blastocyst formation (p<0.05). ROC analysis showed rFSH-HMG had the strongest predictive value for blastocyst formation (AUC=0.963), followed by HMG (0.880) and rFSH (0.774).
Conclusions: Second-cycle IVF/ICSI outcomes improved across several embryological parameters, suggesting beneficial effects of prior stimulation or clinical adjustments. rFSH showed consistent improvement, while rFSH-HMG was the strongest predictor of blastocyst formation. Recognizing cycle-to-cycle dynamics may enhance individualized stimulation strategies and improve reproductive success.
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References
Fauser BC, Devroey P. Reproductive biology and IVF: ovarian stimulation and luteal phase consequences. Tre Endocrinol Metabol. 2003;14(5):236-42. DOI: https://doi.org/10.1016/S1043-2760(03)00075-4
van Wely M, Kwan I, Burt AL, Thomas J, Vail A, Van der Veen F, Al‐Inany HG. Recombinant versus urinary gonadotropin for ovarian stimulation in assisted reproductive technology cycles. Cochr Data System Revi. 2011(2). DOI: https://doi.org/10.1002/14651858.CD005354.pub2
Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Human Reproduct Update. 2006;12(6):685-718. DOI: https://doi.org/10.1093/humupd/dml034
Bosch E, Labarta E, Crespo J, Simón C, Remohí J, Jenkins J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Human Reproduct. 2010;25(8):2092-100. DOI: https://doi.org/10.1093/humrep/deq125
Yehia M. Luteal phase support in assisted reproduction. Midd East Fertil Soci J. 2007;12(3):158-67.
Polyzos NP, Devroey P. A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel?. Fertil Steril. 2011;96(5):1058-61. DOI: https://doi.org/10.1016/j.fertnstert.2011.09.048
Schenker JG. Ovulation Induction: Adverse Effects. In: Frontiers in Gynecological Endocrinology: Volume 1: From Symptoms to Therapies. Cham: Springer International Publishing; 2014:103-118. DOI: https://doi.org/10.1007/978-3-319-03494-2_10
La Marca A, Papaleo E, Grisendi V, Argento C, Giulini S, Volpe A. Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle‐stimulating hormone starting dose in in vitro fertilisation cycles. BJOG: Int J Obstetr Gynaecol. 2012;119(10):1171-9. DOI: https://doi.org/10.1111/j.1471-0528.2012.03412.x
Ziebe S, Lundin K, Janssens R, Helmgaard L, Arce JC. Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF. Human Reproduct. 2007;22(9):2404-13. DOI: https://doi.org/10.1093/humrep/dem221
Bosch E, Vidal C, Labarta E, Simon C, Remohi J, Pellicer A. Highly purified hMG versus recombinant FSH in ovarian hyperstimulation with GnRH antagonists-a randomized study. Human Reproduct. 2008;23(10):2346-51. DOI: https://doi.org/10.1093/humrep/den220
Hussain SS, Hassan MF. The effectiveness of using r-HMG+ r-FSH vs. r-FSH alone during COS on ICSI outcome. Ann Trop Medi Publ Health. 2019;22:82-6. DOI: https://doi.org/10.36295/ASRO.2019.22089
Popovic-Todorovic B, Loft A, Ziebe S, Andersen AN. Impact of recombinant FSH dose adjustments on ovarian response in the second treatment cycle with IVF or ICSI in" standard" patients treated with 150 IU/day during the first cycle. Acta Obstetr Gynecolog Scandi. 2004;83(9):842-9. DOI: https://doi.org/10.1080/j.0001-6349.2004.00573.x
Andersen AN, Devroey P, Arce JC. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial. Human Reproduct. 2006;21(12):3217-27. DOI: https://doi.org/10.1093/humrep/del284
Hu Z, Zeng R, Gao R, Chen M, Liu X, Zhang Q, et al. Effects of different gonadotropin preparations in GnRH antagonist protocol for patients with polycystic ovary syndrome during IVF/ICSI: a retrospective cohort study. Fronti Endocrinol. 2024;15:1309993. DOI: https://doi.org/10.3389/fendo.2024.1309993
Bühler KF, Fischer R, Verpillat P, Allignol A, Guedes S, Boutmy E, et al. Comparative effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) versus highly purified urinary human menopausal gonadotropin (hMG HP) in assisted reproductive technology (ART) treatments: a non-interventional study in Germany. Reproduct Biol Endocrinol. 2021;19(1):90. DOI: https://doi.org/10.1186/s12958-021-00768-3
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