Oocyte Numbers, Fertilization (IVF) Rates of Recovered Oocytes, and Pregnancy Rate in 1035 Cycles of Controlled Ovarian Hyperstimulation (COH) With FSH Alone (Urinary FSH [uFSH], Purified uFSH [hpFSH] or Recombinant FSH [rFSH]); or With FSH and Urinary Gonadotropins (hMG)

Abstract

Objectives: There is ongoing debate regarding the importance of FSH purity, and need for LH, during COH of patients following pituitary down-regulation. This study analyses oocyte yields and IVF rates after COH with FSH alone, or with FSH and hMG. Age interactions are also examined.Design: Retrospective analysis of outcomes of 1035 IVF cycles in an ART center.Materials and Methods: Patients started COH on the 3rd day of the cycle following down-regulation. Initial gonadotropin dosages were 4 amps/day, reviewed following 5 days. Oocyte retrieval (OPU) was scheduled 34hr after the leading follicle(s) reached 18 mm diameter, and serum estradiol approached 250 pg/mL/follicle >15 mm diameter. Oocytes were inseminated 3–5 hours after OPU, and fertilization checked 17–18 hrs later. Results were analyzed by 2-way ANOVA (Stim × Age).Results: Values in the following table are average ± SEM (15–221 cycles/cell). Tabled 1AgeuFSHuFSH+hMG# Oocytes≤4018.3 ± 1.314.4 ± 0.6Fertilization(%)61.4 ± 3.560.2 ± 2.1# Oocytes>4018.3 ± 1.912.9 ± 0.7Fertilization(%)73.6 ± 3.966.1 ± 2.1 Open table in a new tab Tabled 1hpFSHhpFSH+hMGrFSHrFSH+hMG15.3 ± 0.614.2 ± 1.013.9 ± 1.610.1 ± 0.870.7 ± 2.566.8 ± 3.570.9 ± 3.771.9 ± 4.413.8 ± 0.810.4 ± 0.912.6 ± 3.012.5 ± 1.872.4 ± 2.458.1 ± 4.578.7 ± 1.650.6 ± 9.9 Open table in a new tab Average numbers of embryos transferred following IVF were similar for all groups (near 3.6/patient), and pregnancy rates did not differ significantly between groups within each age category (near 48% <40 yrs; near 40% for patients >40 yrs). Oocyte yields decreased as the purity of the FSH increased (P<0.05), independent of patient age. Substitution of FSH with hMG also decreased oocyte yields (P<0.05), an effect which diminished as the purity of the FSH increased. Fertilization rates were directly related to the purity of the FSH. Substitution of FSH with hMG did not impact these values in younger patients, but decreased fertilization rates for older patients (P<0.01).Conclusions: Purer forms of FSH therefore yielded lower numbers of oocytes with greater fertilization potential. Substitution of hMG for FSH decreased oocyte yield, compounded in patients >40 yrs by lower fertilization rates. Pregnancy outcomes indicate that, within age categories, the quality of transferred embryos was not impacted by FSH purity or by differing FSH:LH ratios. Objectives: There is ongoing debate regarding the importance of FSH purity, and need for LH, during COH of patients following pituitary down-regulation. This study analyses oocyte yields and IVF rates after COH with FSH alone, or with FSH and hMG. Age interactions are also examined. Design: Retrospective analysis of outcomes of 1035 IVF cycles in an ART center. Materials and Methods: Patients started COH on the 3rd day of the cycle following down-regulation. Initial gonadotropin dosages were 4 amps/day, reviewed following 5 days. Oocyte retrieval (OPU) was scheduled 34hr after the leading follicle(s) reached 18 mm diameter, and serum estradiol approached 250 pg/mL/follicle >15 mm diameter. Oocytes were inseminated 3–5 hours after OPU, and fertilization checked 17–18 hrs later. Results were analyzed by 2-way ANOVA (Stim × Age). Results: Values in the following table are average ± SEM (15–221 cycles/cell). Tabled 1AgeuFSHuFSH+hMG# Oocytes≤4018.3 ± 1.314.4 ± 0.6Fertilization(%)61.4 ± 3.560.2 ± 2.1# Oocytes>4018.3 ± 1.912.9 ± 0.7Fertilization(%)73.6 ± 3.966.1 ± 2.1 Open table in a new tab Tabled 1hpFSHhpFSH+hMGrFSHrFSH+hMG15.3 ± 0.614.2 ± 1.013.9 ± 1.610.1 ± 0.870.7 ± 2.566.8 ± 3.570.9 ± 3.771.9 ± 4.413.8 ± 0.810.4 ± 0.912.6 ± 3.012.5 ± 1.872.4 ± 2.458.1 ± 4.578.7 ± 1.650.6 ± 9.9 Open table in a new tab Average numbers of embryos transferred following IVF were similar for all groups (near 3.6/patient), and pregnancy rates did not differ significantly between groups within each age category (near 48% <40 yrs; near 40% for patients >40 yrs). Oocyte yields decreased as the purity of the FSH increased (P<0.05), independent of patient age. Substitution of FSH with hMG also decreased oocyte yields (P<0.05), an effect which diminished as the purity of the FSH increased. Fertilization rates were directly related to the purity of the FSH. Substitution of FSH with hMG did not impact these values in younger patients, but decreased fertilization rates for older patients (P<0.01). Conclusions: Purer forms of FSH therefore yielded lower numbers of oocytes with greater fertilization potential. Substitution of hMG for FSH decreased oocyte yield, compounded in patients >40 yrs by lower fertilization rates. Pregnancy outcomes indicate that, within age categories, the quality of transferred embryos was not impacted by FSH purity or by differing FSH:LH ratios.