A Comparison of Outcomes from In Vitro Fertilization Cycles Stimulated with Follicle Stimulating Hormone Plus either Recombinant Luteinizing Hormone or Human Menopausal Gonadotropins in Subjects Treated with Long Gonadotropin Releasing Hormone Agonist Protocols

Abstract

Background: This study compared rates of pregnancy and in vitro fertilization (IVF) parameters in subjects stimulated with follicle stimulating hormone (FSH) plus either recombinant human luteinizing hormone (r-LH) or human menopausal gonadotropin (hMG) in a long gonadotropin releasing hormone (GnRH) agonist IVF protocol.

Materials and methods: This cohort study enrolled patients who underwent IVF stimu- lation with a long GnRH agonist protocol and received FSH plus r-LH or hMG. Outcomes measured included: FSH and LH doses, number of oocytes and embryos obtained, pregnancy rate per cycle, and clinical pregnancy rate per cycle. Stepwise logistic regression was performed on continuous and categorical variables to control for confounding effects between all variables analyzed.

Results: There were 122 patients who underwent 122 IVF cycles with long GnRH agonist protocols. Similar baseline parameters existed between groups. Patients that received r-LH required a lower FSH dose (3207 ± 1300 IU) for stimulation compared to the group that received hMG (4213 ± 1576 IU, P=0.0001). The LH dose was also lower in these patients (1332 ± 587 IU) compared to the patients who received hMG (1938 ± 1110 IU, P=0.0001). The number of days of stimulation did not differ between groups (P=1.0). The group that received r-LH also had statistically higher numbers of oocytes (14.4 ± 6.3) and embryos (7.9 ± 4.8) compared to the hMG group with 11.0 ± 5.3 oocytes and 6.0 ± 3.7 embryos. Pregnancy rates per cycle start were higher for patients in the r-LH group (49%) compared to the hMG group (27%, P=0.025). Patients that received r-LH had higher implantation rates (62%) compared to the hMG group (33%, P=0.001). The r-LH group had a higher trend toward clinical pregnancy rates per cycle start (39%) compared to the hMG group (25%, P=0.065).

Conclusion: r-LH may offer benefits compared to hMG when combined with FSH for ovarian stimulation in long GnRH agonist protocols in good responders. Prospective studies should be undertaken to confirm these results.

Keywords: Human Menopausal Gonadotropins; In Vitro Fertilization; Luteinizing Hormone; Ovarian Stimulation.