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KMID : 1033620220490020135
Clinical and Experimental Reproductive Medicine
2022 Volume.49 No. 2 p.135 ~ p.141
Consecutive versus concomitant follicle-stimulating hormone and highly purified human menopausal gonadotropin: A milder response but better quality
Maghraby Hassan Ali

Agameya Abdel Fattah Mohamed
Swelam Manal Shafik
El Dabah Nermeen Ahmed
Ahmed Ola Youssef
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.
KEYWORD
Follicle-stimulating hormone, Human chorionic gonadotropin, Intracytoplasmic sperm injection outcomes, Purified human menopausal gonadotropin, Soluble Fas
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