title: Meta-analysis of recombinant versus urinary-derived FSH: an update.
abstract: BACKGROUND
  The study aim was to analyse the results of randomized controlled trials (RCTs) comparing recombinant FSH and urinary-derived FSH gonadotrophins [hMG, urinary purified FSH (FSH-P) and highly purified FSH (FSH-HP)] in an IVF/ICSI programme.
  
  
  METHODS
  All published truly RCTs using a long protocol of GnRH agonists for down-regulation, were reviewed. Data of pregnancy rate per started cycle were extracted, and odds ratios (OR) calculated using a fixed effect model. Subgroup analysis was carried out to compare recombinant FSH (rFSH) with each product (hMG alone, FSH-P alone and FSH-HP alone).
  
  
  RESULTS
  There was no statistically significant difference in the pregnancy rate per started cycle between rFSH and urinary-derived FSH gonadotrophins (OR 1.07; 95% CI 0.94-1.22). Subgroup analysis showed no statistically significant difference in the pregnancy rate per started cycle between rFSH versus hMG (OR 0.81; 95% CI 0.63-1.05), rFSH versus FSH-P (OR 1.24; 95% CI 0.98-1.58) and rFSH versus FSH-HP (OR 1.14; 95% CI 0.94-1.40). There was no significant heterogeneity of treatment effect across the trials.
  
  
  CONCLUSIONS
  There is no evidence of clinical superiority in clinical pregnancy rate for rFSH over different urinary-derived FSH gonadotrophins. Additional factors should be considered when choosing a gonadotrophin regimen, including the cost, patient acceptability, safety and drug availability.
authors.affiliation: The Egyptian IVF-ET Center, Maadi, Cairo and Cairo University, Department of Obstetrics and Gynecology, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Al-Inany
authors.forename: Mohamed
authors.initials: M
authors.lastname: Aboulghar
authors.forename: Ragaa
authors.initials: R
authors.lastname: Mansour
authors.forename: Gamal
authors.initials: G
authors.lastname: Serour
mesh_terms: D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000235:genetics / Q000302:isolation & purification / Q000627:therapeutic use* / Q000652:urine*; D006801:Humans; D008596:Menotropins / Q000627:therapeutic use; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D011995:Recombination, Genetic; D020554:Sperm Injections, Intracytoplasmic; D014556:Urine / Q000737:chemistry
chemical_list: D008596:Menotropins; D005640:Follicle Stimulating Hormone