title: Outcome of in vitro fertilization following stimulation with highly purified hMG or recombinant FSH in downregulated women of advanced reproductive age: a prospective, randomized and controlled trial.
abstract: OBJECTIVE
  To compare highly purified human menopausal gonadotropin (HP-hMG) with recombinant follicle-stimulating hormone (rFSH) on ovarian response and pregnancy outcome in downregulated women of advanced reproductive age.
  
  
  METHODS
  A prospective, randomized and controlled study of 127 consecutive normogonadotropic infertile women ≥ 35 years old undergoing their first in vitro fertilization/intracytoplasmic sperm injection cycles received ovarian stimulation with HP-hMG (n = 63) or with rFSH (n = 64) in a long gonadotropin-releasing hormone agonist protocol.
  
  
  RESULTS
  More leading (≥ 18 mm) follicles and oocytes were obtained in rFSH group (p = 0.008 and p < 0.001, respectively). The proportion of top-quality embryo from oocyte retrieval and live birth rate per started cycle trended towards improvement with HP-hMG (OR 1.3, 95% CI 0.9-1.8; OR 1.9, 95% CI 0.9-3.9; respectively), although they were not significant difference between two groups. At end of stimulation, higher serum progesterone level was found in rFSH group (p < 0.001).
  
  
  CONCLUSIONS
  Following downregulated women of advanced reproductive age, superiority of HP-hMG over rFSH in live birth rate could not be concluded from this study, but noninferiority was established. Pharmacodynamic differences in follicular development, oocyte/embryo quality and endocrine response exist between HP-hMG and rFSH, which may be relevant to treatment outcome.
authors.affiliation: Chongqing Reproductive and Genetic Institute, Chongqing Obstetrics and Gynecology Hospital, Chongqing, China. yehong1210@163.com
authors.forename: Hong
authors.initials: H
authors.lastname: Ye
authors.forename: Guoning
authors.initials: G
authors.lastname: Huang
authors.forename: Li
authors.initials: L
authors.lastname: Pei
authors.forename: Pinghong
authors.initials: P
authors.lastname: Zeng
authors.forename: Xiu
authors.initials: X
authors.lastname: Luo
mesh_terms: D000328:Adult; D000375:Aging; D001723:Birth Rate; D004477:Ectogenesis / Q000187:drug effects; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology; D005307:Fertilization in Vitro; D043373:Follicle Stimulating Hormone, Human / Q000494:pharmacology*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008596:Menotropins / Q000494:pharmacology*; D009866:Oogenesis / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods*; D010902:Pituitary Gland / Q000187:drug effects* / Q000503:physiopathology; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D011994:Recombinant Proteins / Q000494:pharmacology; D020554:Sperm Injections, Intracytoplasmic; D017329:Triptorelin Pamoate / Q000494:pharmacology*
chemical_list: D005300:Fertility Agents, Female; D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D008596:Menotropins