A prospective randomized and blinded comparison between urinary and recombinant HCG for oocyte maturation in IVF cycles

Abstract

Objective: It is well known that both hCG and LH can stimulate the same receptor. The hCG extracted from urine from pregnant women has been widely used in the induction of oocyte maturation in IVF cycles. Lack of purity and variation in activity have been cited as possible disadvantages of urinary hCG. Choriogonadotropin alfa (Ovidrel®, Serono Inc., Sao Paulo, SP) is a recombinant hCG (rhCG) preparation purified by repeated chromatographic steps in order to produce a drug with a high specific activity. The objective of this study was to compare the effects of conventional urinary hCG (Profasi HP, Serono Inc., Sao Paulo, SP) to those of recombinant hCG (Ovidrel®, Serono Inc., Sao Paulo, SP) in IVF cycles.Design: Eighty patients undergoing IVF cycles were randomically assigned, on the day of hCG administration for oocyte maturation, to receive either urinary hCG (Profasi HP® 10000 IU, Serono Inc, São Paulo, SP) or recombinant hCG (Ovidrel® 250mg, Serono Inc., Sao Paulo, SP).Materials and Methods: Patients ≤ 35 years old with IVF indication were submitted to a standard long GnRH protocol of ovarian stimulation performed with recombinant FSH (Gonal F®, Serono Inc, São Paulo, SP). The response was monitored by ultrasound and the hCG prescribed when two or more follicles ≥ 18mm were detected. Physicians responsible for oocyte retrieval and embryo transfer as well as the laboratory staff were not informed regarding the patient’s randomization status. Statistical evaluation was performed with unpaired t test, Fisher’s exact and Mann-Whitney test as appropriate.Results: The comparison of outcomes for the two groups showed no statistical difference in relation to total number of retrieved oocytes, percentage of mature oocytes, number of injected oocytes, fertilization rates, number of embryos transferred and positive beta hCG, although our data indicate a possible trend toward a higher incidence of pregnancy in Ovidrel group. Tabled 1Conclusion: The recombinant hCG is a safe and at least equally efficient drug for inducing the final stages of oocyte maturation as urinary hCG. Objective: It is well known that both hCG and LH can stimulate the same receptor. The hCG extracted from urine from pregnant women has been widely used in the induction of oocyte maturation in IVF cycles. Lack of purity and variation in activity have been cited as possible disadvantages of urinary hCG. Choriogonadotropin alfa (Ovidrel®, Serono Inc., Sao Paulo, SP) is a recombinant hCG (rhCG) preparation purified by repeated chromatographic steps in order to produce a drug with a high specific activity. The objective of this study was to compare the effects of conventional urinary hCG (Profasi HP, Serono Inc., Sao Paulo, SP) to those of recombinant hCG (Ovidrel®, Serono Inc., Sao Paulo, SP) in IVF cycles. Design: Eighty patients undergoing IVF cycles were randomically assigned, on the day of hCG administration for oocyte maturation, to receive either urinary hCG (Profasi HP® 10000 IU, Serono Inc, São Paulo, SP) or recombinant hCG (Ovidrel® 250mg, Serono Inc., Sao Paulo, SP). Materials and Methods: Patients ≤ 35 years old with IVF indication were submitted to a standard long GnRH protocol of ovarian stimulation performed with recombinant FSH (Gonal F®, Serono Inc, São Paulo, SP). The response was monitored by ultrasound and the hCG prescribed when two or more follicles ≥ 18mm were detected. Physicians responsible for oocyte retrieval and embryo transfer as well as the laboratory staff were not informed regarding the patient’s randomization status. Statistical evaluation was performed with unpaired t test, Fisher’s exact and Mann-Whitney test as appropriate. Results: The comparison of outcomes for the two groups showed no statistical difference in relation to total number of retrieved oocytes, percentage of mature oocytes, number of injected oocytes, fertilization rates, number of embryos transferred and positive beta hCG, although our data indicate a possible trend toward a higher incidence of pregnancy in Ovidrel group. Tabled 1 Conclusion: The recombinant hCG is a safe and at least equally efficient drug for inducing the final stages of oocyte maturation as urinary hCG.