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Consecutive versus concomitant follicle-stimulating hormone and highly purified human menopausal gonadotropin: A milder response but better quality

Clinical and Experimental Reproductive Medicine 2022년 49권 2호 p.135 ~ 141
Maghraby Hassan Ali, Agameya Abdel Fattah Mohamed, Swelam Manal Shafik, El Dabah Nermeen Ahmed, Ahmed Ola Youssef,
소속 상세정보
 ( Maghraby Hassan Ali ) - Alexandria University Faculty of Medicine Department of Obstetrics and Gynecology
 ( Agameya Abdel Fattah Mohamed ) - Alexandria University Faculty of Medicine Department of Obstetrics and Gynecology
 ( Swelam Manal Shafik ) - Alexandria University Faculty of Medicine Department of Obstetrics and Gynecology
 ( El Dabah Nermeen Ahmed ) - Alexandria University Faculty of Medicine Department of Clinical Pathology
 ( Ahmed Ola Youssef ) - Alexandria University Faculty of Medicine Department of Obstetrics and Gynecology

Abstract


Objective: This study investigated the impact of two stimulation protocols using highly purified human menopausal gonadotropin (HP-hMG) on the endocrine profile, follicular fluid soluble Fas levels, and outcomes of intracytoplasmic sperm injection (ICSI) cycles.

Methods: This prospective clinical trial included 100 normal-responder women undergoing ovarian stimulation for ICSI; 55 patients received concomitant follicle-stimulating hormone (FSH) plus HP-hMG from the start of stimulation, while 45 patients received FSH followed by HP-hMG during mid/late follicular stimulation. The primary outcome was the number of top-quality embryos. The secondary outcomes were the number and percentage of metaphase II (MII) oocytes and the clinical pregnancy rate.

Results: The number of MII oocytes was significantly higher in the concomitant protocol (median, 13.0; interquartile range [IQR], 8.5?18.0 vs. 9.0 [8.0?13.0] in the consecutive protocol; p=0.009); however, the percentage of MII oocytes and the fertilization rate were significantly higher in the consecutive protocol (median, 90.91; IQR, 80.0?100.0 vs. 83.33 [75.0?93.8]; p=0.034 and median, 86.67; IQR, 76.9?100.0 vs. 77.78 [66.7?89.9]; p=0.028, respectively). No significant between-group differences were found in top-quality embryos (p=0.693) or the clinical pregnancy rate (65.9% vs. 61.8% in the consecutive vs. concomitant protocol, respectively). The median follicular fluid soluble Fas antigen level was significantly higher in the concomitant protocol (9,731.0 pg/mL; IQR, 6,004.5?10,807.6 vs. 6,350.2 pg/mL; IQR, 4,382.4?9,418.4; p=0.021).

Conclusion: Personalized controlled ovarian stimulation using HP-hMG during the late follicular phase led to a significantly lower response, but did not affect the quality of ICSI.

키워드

Follicle-stimulating hormone; Human chorionic gonadotropin; Intracytoplasmic sperm injection outcomes; Purified human menopausal gonadotropin; Soluble Fas

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