title: Controlled Ovarian Stimulation with recombinant-FSH plus recombinant-LH vs. human Menopausal Gonadotropin based on the number of retrieved oocytes: results from a routine clinical practice in a real-life population.
abstract: BACKGROUND
  The association of recombinant FSH (rFSH) plus recombinant LH (rLH) is currently used for Controlled Ovarian Stimulation (COS) in human IVF, but its efficacy has, to date, not yet been compared to that of human Menopausal Gonadotropin (hMG), the FSH + LH activity-containing urinary drug.
  
  
  METHODS
  Eight hundred forty-eight (848) IVF patients classified as expected "poor" or "normal" responders according to antral follicle count (AFC) and basal (day 3) FSH were treated with rFSH + rLH (2:1 ratio, n = 398, Group A) or hMG (n = 450, Group B). Data were collected under real-life practice circumstances and the pregnancy rate with fresh embryos was calculated by stratifying patients according to the number of retrieved oocytes (1-2, 3-4, 5-6, 7-8, >8).
  
  
  RESULTS
  Overall, the pregnancy rate in both groups progressively improved according to the number of oocytes retrieved. When comparing patients within the same subgroup of oocyte yield, Group A and B showed a comparable outcome up to the reported highest yield (>8). When more than 8 oocytes were available, Group A had a significantly better pregnancy rate outcome. Patients' characteristics did not significantly differ between the two groups and the better outcome in the best responding patients in Group A was confirmed by a multivariable logistic regression analysis, that showed that both the use of rFSH + rLH and the total number of retrieved oocytes increased the probability of pregnancy with odd ratio (OR) of 1.628 and 1.083, respectively.
  
  
  CONCLUSIONS
  When comparing patients with the same number of retrieved oocytes under real-life circumstances, the association of rFSH + rLH results in a significantly higher pregnancy rate than hMG when more than 8 oocytes are retrieved. The reason(s) for this are unknown, but a more favorable effect on oocyte quality and/or endometrial receptivity could be involved.
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. fertisave@yahoo.com.|LIVET Infertility and IVF Clinic, Torino, Italy. fertisave@yahoo.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Revelli
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. grazia.pettinau@yahoo.it.
authors.forename: Grazia
authors.initials: G
authors.lastname: Pettinau
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. gemmabasso@hotmail.it.
authors.forename: Gemma
authors.initials: G
authors.lastname: Basso
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. andrea88.carosso@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carosso
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. alessandroferrero@hotmail.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. cecilia.dallan@gmail.com.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Dallan
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. s.canosa88@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Canosa
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. gennarelligl@gmail.com.|LIVET Infertility and IVF Clinic, Torino, Italy. gennarelligl@gmail.com.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gennarelli
authors.affiliation: LIVET Infertility and IVF Clinic, Torino, Italy. daniela.guidetti@tin.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Guidetti
authors.affiliation: Statistics, Department of Surgical Sciences, University of Torino, MolinetteHospital, Torino, Italy. claudia.filippini@unito.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Filippini
authors.affiliation: Gynecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy. chiara.benedetto@unito.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetto
mesh_terms: D000328:Adult; D005260:Female; D005640:Follicle Stimulating Hormone / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007986:Luteinizing Hormone / Q000494:pharmacology / Q000627:therapeutic use*; D008596:Menotropins / Q000494:pharmacology / Q000627:therapeutic use*; D054315:Oocyte Retrieval / Q000379:methods; D009865:Oocytes / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone