Highly Purified hMG versus Recombinant FSH for Ovarian Stimulation in IVF Cycles

Article by Dr Jothi Kumar

Highly Purified hMG versus Recombinant FSH for Ovarian Stimulation in IVF Cycles

Dr Jothi Kumar

Obstetrician & Gynaecologist
University of Singapore, Faculty of Medicine
Monash University, Melbourne, Australia
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The authors compared the efficacy of two preparations of exogenous gonadotrophins, Highly Purified (HP) hMG (Menopur) versus Recombinant FSH (Gonal-F), used for ovarian hyperstimulation in In-Vitro Fertilization (IVF) treatment. They conducted a retrospective analysis of the individual data obtained from two large randomized controlled trials, namely the European & Israel Study Group (EISG) 2002 trial and the MERIT 2006 trial. In both trials, randomization to Menopur or Gonal-F for ovarian hyperstimulation was done using the long, down-regulation protocol with the GnRH-agonist commenced in the mid-luteal phase. The primary outcome measures were on-going pregnancy rate and live-birth rate, whilst the secondary outcome measures were clinical pregnancy rate and implantation rate.

The results showed that ovarian hyperstimulation with Menopur resulted in a significantly higher on-going pregnancy and live-birth rates compared with Gonal-F. The superiority of Menopur was also seen with the clinical pregnancy and implantation rates. Moreover, it was also shown that from an economic perspective, it was more cost-effective to use Menopur compared to Gonal-F.

The better efficacy of Menopur is postulated to be attributable to the presence of FSH and LH activities in a 1:1 ratio in this preparation, compared to the absence of any LH activity in the Gonal-F preparation. Moreover, from the safety point of view, there was no significant difference between these two drugs in terms of the maternal risks and neonatal outcomes of miscarriages, multiple pregnancy, ectopic pregnancy, severe ovarian hyperstimulation syndrome (OHSS) or congenital abnormalities. Hence, the benefit-risk ratio seems to favour the use of HP-hMG over Recombinant FSH for ovarian hyperstimulation in IVF treatment cycles.


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