Updated meta-analysis of recombinant follicle-stimulating hormone (FSH) versus urinary FSH for ovarian stimulation in assisted reproduction.
OBJECTIVE
To determine the relative efficacy of recombinant FSH (rFSH) and urinary FSH (uFSH) for ovarian stimulation in assisted reproductive techniques (ART).


METHODS
Systematic review and meta-analysis of randomized, controlled trials comparing rFSH and uFSH.


METHODS
Infertility centers providing treatment with ART.


METHODS
Patients undergoing IVF with or without ICSI.


METHODS
Controlled ovarian stimulation using uFSH or rFSH (follitropin alpha or follitropin beta).


METHODS
Primary: rate of clinical pregnancy per cycle. Secondary: rates of spontaneous abortion, multiple pregnancy, and severe ovarian hyperstimulation syndrome (OHSS); total gonadotropin dose; serum E(2) level and number of follicles at hCG administration; number of oocytes retrieved.


RESULTS
Eighteen trials were included in the meta-analysis. Subgroup analyses demonstrated higher pregnancy rates with both follitropins compared with uFSH. However, statistical significance was reached only in the follitropin alpha versus uFSH comparison in IVF cycles, with an additional pregnancy for every 19 patients treated. Fewer units of rFSH than uFSH achieved the same E(2) level and oocyte yield. No differences were found between treatments in rates of spontaneous abortion, OHSS, and multiple gestation.


CONCLUSIONS
rFSH produced higher pregnancy rates per cycle than uFSH when follitropin alpha was used in IVF, and the total gonadotropin dose required was lower.
Daya
Salim
S
Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada L8N 3Z5. dayas@mcmaster.ca
D000022:Abortion, Spontaneous / Q000453:epidemiology; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage / Q000627:therapeutic use*; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology; D010062:Ovulation Induction; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D027724:Reproductive Techniques, Assisted; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
D011994:Recombinant Proteins; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone