Urinary hMG versus recombinant FSH for controlled ovarian hyperstimulation following an agonist long down-regulation protocol in IVF or ICSI treatment: a systematic review and meta-analysis

BACKGROUND Since the most recent Cochrane review on hMG versus rFSH for controlled ovarian hyperstimulation following a long down-regulation protocol, several new trials have emerged. METHODS We conducted a systematic review and meta-analysis of randomized trials comparing the effectiveness of hMG v...

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Bibliographic Details
Published in:Human reproduction (Oxford) 2008-02, Vol.23 (2), p.310-315
Main Authors: Coomarasamy, Arri, Afnan, Masoud, Cheema, Deepti, van der Veen, Fulco, Bossuyt, Patrick M.M., van Wely, Madelon
Format: Article
Language:English
Subjects:
Biological and medical sciences
Birth Rate
Female
Fertilization in Vitro
Follicle Stimulating Hormone, Human - therapeutic use
Gynecology. Andrology. Obstetrics
Humans
Live Birth
Medical sciences
Menotropins - therapeutic use
Ovulation Induction - methods
Pregnancy
Pregnancy Rate
Randomized Controlled Trials as Topic
Recombinant Proteins - therapeutic use
Sperm Injections, Intracytoplasmic
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Summary:BACKGROUND Since the most recent Cochrane review on hMG versus rFSH for controlled ovarian hyperstimulation following a long down-regulation protocol, several new trials have emerged. METHODS We conducted a systematic review and meta-analysis of randomized trials comparing the effectiveness of hMG versus rFSH following a long down-regulation protocol in IVF–ICSI cycles, on the primary outcome of live birth per woman randomized, as well as several other secondary outcomes. Searches were conducted in MEDLINE, EMBASE, Science Direct, Cochrane Library and databases of abstracts (last search January 2007). RESULTS Seven randomized trials, consisting of a total of 2159 randomized women, were identified. A meta-analysis of these trials showed a significant increase in live birth rate with hMG when compared with rFSH (relative risk, RR = 1.18, 95% CI: 1.02–1.38, P = 0.03). The heterogeneity test was non-significant (P = 0.97), suggesting that there was no statistical inconsistency between the seven studies. The pooled risk difference (RD) for the outcome of live birth rate was 4% (95% CI: 1–7%) for these study populations. There was an increase in clinical pregnancy rates with hMG when compared with rFSH (RR = 1.17, 95% CI 1.03–1.34). No significant differences were noted for gonadotrophin use, spontaneous abortion, multiple pregnancy, cancellation and ovarian hyperstimulation syndrome rates. CONCLUSIONS For the populations in the randomized trials, hMG was associated with a pooled 4% increase in live birth rate when compared with rFSH in IVF–ICSI treatment following a long down-regulation protocol.
ISSN:0268-1161
1460-2350
DOI:10.1093/humrep/dem305