Optimizing ovarian stimulation in oocyte donation: exploratory comparison of rhFSH (2:1) versus hp-hMG under PPOS protocols.
In this exploratory study, rhFSH:rhLH resulted in a higher mean number of good-morphology blastocysts compared to hp-hMG, but further research is necessary to validate these findings.
Where it sits
this study against the rest of the triptorelin corpusSummary and findings
This study compared embryological outcomes in oocyte donors undergoing progesterone-primed ovarian stimulation with either rhFSH:rhLH (2:1) or hp-hMG. A total of 36 donor cycles were analyzed, with 26 receiving rhFSH:rhLH and 10 receiving hp-hMG. The findings indicated a higher mean number of good-morphology blastocysts with rhFSH:rhLH.
Abstract
<h4>Objective</h4>To describe embryological outcomes in oocyte donors undergoing progesterone-primed ovarian stimulation (PPOS) with either recombinant human follicle-stimulating hormone (rhFSH): recombinant human luteinizing hormone (rhLH) (2:1) or highly purified human menopausal gonadotropin (hp-hMG).<h4>Methods</h4>Young, healthy donors began PPOS on cycle day 2 and were sequentially allocated into an observational case series study. Donors receive either rhFSH:rhLH (2:1) or hp-hMG (both at 225IU/day; n=26 and n=10 donor cycles, respectively). Final oocyte maturation was triggered with triptorelin 0.2 mg. Retrieved oocytes were fertilized by ICSI, and embryos were cultured to the blastocyst stage and graded. A subset of blastocysts underwent PGT-A biopsy prior to vitrification. The oocyte retrieval team and embryologists were blinded to treatment allocation.<h4>Results</h4>Baseline donor characteristics were similar. Donor cycles allocated to rhFSH:rhLH showed numerically higher oocyte yield, metaphase II oocytes, 2PN fertilization, and total blastocyst formation. The mean number of good-morphology blastocysts per cycle was approximately two-fold higher with rhFSH:rhLH (4.5 vs. 2.0). Following an interim descriptive review of the first ten hp-hMG cases showing suboptimal embryological outcomes, further allocation to hp-hMG was discontinued as a programmatic decision. No inferential statistical testing was performed, consistent with the exploratory case series.<h4>Conclusion</h4>In this exploratory case series, rhFSH:rhLH within PPOS demonstrated more favorable laboratory outcomes. These results generate hypotheses and support the need for further studies to confirm the observations and determine their clinical relevance in oocyte donation programs.
Background
This paper addresses the optimization of ovarian stimulation protocols in oocyte donation, specifically comparing rhFSH:rhLH and hp-hMG. Previous studies have indicated varying outcomes with different stimulation protocols, highlighting the need for further exploration in this area. Understanding the embryological outcomes can inform best practices in assisted reproductive technologies.
Methods
The study utilized an observational case series design with young, healthy oocyte donors. A total of 36 donor cycles were included, with 26 receiving rhFSH:rhLH (2:1) and 10 receiving hp-hMG, both at a dose of 225 IU/day. Final oocyte maturation was triggered with triptorelin 0.2 mg, and outcomes were assessed based on oocyte yield and blastocyst formation.
Results
The mean number of good-morphology blastocysts per cycle was 4.5 for rhFSH:rhLH and 2.0 for hp-hMG. No inferential statistical testing was performed, and the study noted numerically higher outcomes for rhFSH:rhLH in terms of oocyte yield and fertilization rates.
Interpretation
The findings suggest that rhFSH:rhLH may lead to better embryological outcomes compared to hp-hMG, although the lack of statistical testing limits the ability to draw firm conclusions. The effect size appears significant, but the clinical relevance remains uncertain due to the exploratory nature of the study and the small sample size for hp-hMG. These results warrant further investigation to confirm the observations.
Key findings
- Mean number of good-morphology blastocysts per cycle was 4.5 with rhFSH:rhLH vs 2.0 with hp-hMG.
- No inferential statistical testing was performed.
- Donor cycles allocated to rhFSH:rhLH showed numerically higher oocyte yield, metaphase II oocytes, 2PN fertilization, and total blastocyst formation.
- Further allocation to hp-hMG was discontinued after ten cases due to suboptimal embryological outcomes.
Limitations
- Exploratory case series design with no inferential statistical testing.
- Small sample size for hp-hMG (n=10) raises reliability concerns.
- No long-term follow-up data reported.