A retrospective, matched case-control study of recombinant LH versus hMG supplementation on FSH during controlled ovarian hyperstimulation in the GnRH-antagonist protocol

Assisted Reproductive Technology Outcomes in Women with Normal Ovarian Response Receiving Recombinant Luteinizing Hormone/Human Menopausal Gonadotropin: An Observational Study

Objective

Additive human menopausal gonadotropin (HMG)/recombinant luteinizing hormone (r-LH) to follicle-stimulating hormone (FSH) can improve pregnancy outcomes in patients with poor ovarian response during assisted reproductive procedures. However, their effects on patients with normal ovarian response during such procedures are unclear, which formed the aim of this study.

Methods

This retrospective study enrolled 456 infertile women who underwent in vitro fertilization or intracytoplasmic sperm injection treatment. Group 1 received FSH; Group 2 received FSH+HMG/r-LH; Group 3 received FSH+HMG+r-LH.

Results

The age and Body Mass Index were significantly greater in Group III. The endometrial thickness was greater in Groups II and III, suggesting better endometrial receptivity. Better pregnancy and birth outcomes were seen in Group 3. In sub-cohorts of women older than 32 years old or with overweight/obesity, pregnancy and birth outcomes were also much better in Group 3, albeit without statistical significance.

Conclusion

The addition of both HMG and r-LH to FSH may improve the chance of infertile women with normal ovarian responses to have more success in having live birth babies, specifically in those over 32 years of age or with overweight/obese patients who typically face challenges in conceiving and sustaining a pregnancy.

A direct healthcare cost analysis of recombinant LH versus hMG supplementation on FSH during controlled ovarian hyperstimulation in the GnRH-antagonist protocol

PURPOSE

We have previously published a retrospective matched-case control study comparing the effect of recombinant LH (r-hLH) versus highly purified human menopausal gonadotropin (hMG) supplementation on the follicle-stimulating hormone (FSH) during controlled ovarian hyperstimulation (COH) in the GnRH-antagonist protocol. The result from that study showed that the cumulative live birth rate (CLBR) was significantly higher in the r-hLH group (53% vs. 64%, p = 0.02). In this study, we aim to do a cost analysis between these two groups based on our previous study.

METHODS

The analysis consisted of 425 IVF and ICSI cycles in our previous study. There were 259 cycles in the r-hFSH + hMG group and 166 cycles in the r-hFSH + r-hLH group. The total cost related to the treatment of each patient was recorded. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were performed and created.

RESULTS

The total treatment cost per patient was significantly higher in the r-hFSH + r-hLH group than in the r-hFSH + hMG group ($4550 ± 798.86 vs. $4290 ± 734.6, p = 0.003). However, the mean cost per live birth in the r-hFSH + hMG group was higher at $8052, vs. $7059 in the r-hFSH + r-hLH group. The CEAC showed that treatment with hFSH + r-hLH proved to be more cost-effective than treatment with r-hFSH + hMG. Willingness-to-pay was evident when considering a hypothetical threshold of $18,513, with the r-hFSH + r-hLH group exhibiting a 99% probability of being considered cost-effective.

CONCLUSION

The cost analysis showed that recombinant LH is more cost-effective than hMG supplementation on r-hFSH during COH in the GnRH-antagonist protocol.

The clinical application value of gonadotropin-releasing hormone antagonist combined with low-dose HCG regimen in patients with ovarian hyper-stimulation based on clinical characteristics and laboratory indicators

OBJECTIVE

To explore the clinical application value of gonadotropin-releasing hormone antagonist (GnRH-A) combined with low-dose HCG regimen in patients with high ovarian response based on clinical characteristics and laboratory indicators.

METHODS

The clinical data of 305 patients who received IVF/ICSI in the Hechi People's Hospital Reproductive Medicine Center from March 2018 to December 2021 were retrospectively included, and all patients were treated with GnRH-A combined with low-dose HCG regimen protocol. The patients were separated into an ovarian hyper-response group and a normal ovarian reaction group according to their ovarian reactivity. Risk factors for ovarian hyper-response in IVF/ICSI patients were screened by univariate and multivariate logistic analysis. The ROC curve area was used to evaluate the prediction effect.

RESULTS

Of the 305 patients, 6 (1.97%) had poor ovarian reaction, 123 (40.33%) had ovarian hyper response, and 176 (57.70%) had normal ovarian reaction. The proportion of ovarian hyper response and normal ovarian reaction was 98.03% (299/305); the basic serum FSH level, AMH level, E2 on HCG level on HCG injection day and the incidence of moderate to severe OHSS in the Ovarian hyper-response group were compared with those in the normal ovarian reaction group (P < 0.05). Logistic reversion analysis showed that AMH (OR = 1.246, 95% CI = 1.107-1.402), E2 level on HCG injection day (OR = 1.050, 95% CI = 1.028-1.072) and P level on HCG injection day (OR = 5.831, 95% CI = 1.231-27.616) were factors for ovarian hyper response. Basal serum FSH (OR = 0.781, 95% CI = 0.647-0.94) and LH level on HCG injection day (OR = 0.594, 95% CI = 0.405-0.871) were negatively correlated with the occurrence of high response (P < 0.05). ROC curve analysis showed that AMH (AUC = 0.779), E2 level on HCG injection day (AUC = 0.802), P level on HCG injection day (AUC = 0.636), combined detection (AUC = 0.843), AUC > 0.5. Among them, the prediction effect of joint detection is better.

CONCLUSION

GnRH-A combined with low-dose HCG regimen is feasible for patients with ovarian hyper-response during IVF-ET/ICSI, and does not affect the implantation rate, clinical pregnancy rate, live birth rate, and early abortion rate of such patients. Combined detection of basal serum FSH, AMH, LH, E2 and P levels on HCG injection day can effectively predict the occurrence of ovarian hyper-response.