Comparison of controlled ovarian stimulation with human menopausal gonadotropin or recombinant follicle-stimulating hormone

Objective: To carefully examine the features of controlled ovarian stimulation performed with recombinant FSH-alpha or hMG. Design: Controlled, prospective, randomized comparison of fixed gonadotropin regimens. Setting: Academic research institution. Patient(s): Fifty infertile patients who were candidates for IUI. Intervention(s): Patients were randomized to receive a fixed regimen of recombinant FSH-alpha (150 IU/day, 25 patients) or hMG (150 IU/day, 25 patients), after GnRH-agonist suppression (long regimen). Main Outcome Measure(s): Daily measurements of serum LH, immunoreactive FSH, hCG, E-2, P, and T. Transvaginal pelvic ultrasound every 2 days. Pregnancy and abortion rates. Cost of medications. Result(s): Two recombinant FSH-alpha-treated patients did not respond. Despite matched daily FSH dose, duration of treatment (hMG 10.8 +/- 0.4 vs. recombinant FSH-alpha 12.4 +/- 0.5 days), gonadotropin dose (21.7 +/- 0.8 vs. 25.3 +/- 1.3 ampoules), gonadotropin cost (288 +/- 10 vs. 1,299 +/- 66 euro/cycle), serum P levels, and small preovulatory follicle number were significantly lower, and LH, hCG, immunoreactive FSH levels, and larger follicles on day 8 were significantly higher in hMG-treated patients. The pregnancy, abortion, and twin pregnancy rates did not differ. Conclusion(s): The hMG administration was associated with: [1] increased serum LH activity and immunoreactive FSH levels during treatment; [2] reduced signs of premature luteinization; [3] differential modulation of folliculogenesis; [4] lower treatment duration, gonadotropin dose, and cost; and [5] clinical outcome comparable to recombinant FSH-alpha. (C) 2003 by American Society for Reproductive Medicine.