A comparison of meno tropins and recombinant gonadotrophins for controlled ovarians stimulation in ICSI cycles.

[P-769] A COMPARISON OF MENOTROPINS AND RECOMBINANT GONADOTROPHINS FOR CONTROLLED OVARIAN STIMULATION IN ICSI CYCLES.

S. C. Esteves, S. Verza Jr., A. P. Gomes, D. T. Schneider, S. F. Zabaglia. ANDROFERT-Centro de Referência em Infertilidade Masculina, Campinas, Brazil

Objective: The use of different gonadotropins preparations has been advocated based on their role in oocyte maturation, feature in quality and technical development, dosing, and finally it has been largely debated if accuracy will improve efficacy and consequently overall cost. Over a six-year period, we changed from urine-derived to recombinant gonadotropins. We have now audited our clinical practice and compared clinical and laboratory efficacy of three different gonadotropins used for ovarian stimulation in ICSI cycles.

Design: Retrospective study in a tertiary center for male infertility

Material and methods: We retrospectively analyzed 783 consecutive ICSI cycles performed from January 2000 to July 2005. Controlled ovarian hyperstimulation (COH) was achieved using human menopausal gonadotrophin (HMG: Menogon®, Ferring; n=299), highly-purified HMG (HP-HMG: Menopur®, Ferring; n=330) or recombinant FSH (rFSH: Gonal-F®, Serono; n=154). Laboratory and clinical protocols remained unchanged over time, the latter differing only in the type of gonadotropin, being introduced sequentially in our practice, starting with HMG, then HP-HMG and finally rFSH. Data compared included duration of stimulation and total dose of gonadotropin, cancellation rate, number of oocytes retrieved, number of mature oocytes, fertilization rate, percentage of good quality embryos available for transfer, number of transferred embryos, implantation rate, clinical pregnancy rate and spontaneous abortion rate. ANOVA, Kruskal-Wallis and Chi-square tests were used for comparisons, with a alpha level of 0.05 for significance.

Results: Female age, duration of stimulation (days), total dose of gonadotropin, cancellation rate, number of oocytes retrieved, number of mature oocytes, fertilization rate, percentage of good quality embryos available for transfer, number of transferred embryos, implantation, clinical pregnancy, miscarriage and live birth rates were: (32.5±5.3, 34.0±4.7, 34.3±4.8; p<0.001), (9.5±1.3, 9.9±1.3, 10.2±0.9; p<0.001), (2,684±720UI, 2,876±867UI, 2,105±734UI; p=0.001), (7.7%, 6.4%, 6.5%; NS), (10.9±6.8, 10.7±6.5, 11.3±6.8; NS), (8.9±5.6, 8.9±6.5, 9.0±6.0; NS), (72.0±25.0%, 72.0±22.0%, 71.0±23.0%; NS), (40.0±30.0%, 47.0±31.0%, 36.0±28%; p=0.001); (3.4±1.6, 3.4±1.5, 3.3±1.6; NS), (16.0±24.0%, 19.0±27.0%, 15.0±22.0%; NS), (35.5%, 40.0%, 35.1%; NS), (24%, 19%, 6,0%; p=0.03), (27.1%, 32.4%, 32.9%; p=0.04) in HMG, HP-HMG and rFSH groups, respectively.

Conclusion: Our results indicate better laboratory and clinical efficaccy of both HP-HMG and rFSH as compared to HMG for COH in ICSI cycles. Despite the fact that the HMG group included younger patients, which may justify the lower duration of stimulation, a significant higher live birth rate in both HP-HMG and rFSH groups has been achieved as compared to HMG group. Finally, we observed a ~30% reduction in the amount of gonadotropin used for ovarian stimulation when rFSH was introduced to our clinical practice, suggesting a direct impact on overall treatment cost.

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