A prospective, randomized, controlled trial comparing three different gonadotropin regimens in oocyte donors: ovarian response, in vitro fertilization outcome, and analysis of cost minimization

Authors: Marco Melo, Jose Bellver, Nicolas Garrido, Marcos Meseguer, Antonio Pellicer, Jose Remohı

(Fertility & Sterility 94: 958- 964, 2010)

Objective: To compare the efficacy of three different gonadotropin regimens in an oocyte donation program. The analysis of cost minimization also was evaluated.

Design: Prospective, randomized, controlled study.

Setting: Instituto Universitario–IVI, Valencia, Spain.

Patient(s): One thousand twenty-eight donors undergoing a GnRH agonist protocol were assigned randomly to one of three groups: group 1 (n= 346), only recombinant FSH (rFSH); group 2 (n= 333), only highly purified menotropin (HP-hMG); and group 3 (n= 349), rFSH plus HP-hMG. One thousand seventy-nine oocyte recipients.

Intervention(s): Controlled ovarian stimulation. Main Outcome Measure(s): Controlled ovarian stimulation parameters, IVF outcome, and cost analysis.

Result(s): No differences were found among the groups with respect to days of stimulation, gonadotropin dose, final E2 and P levels, number of oocytes retrieved, and cancellation rate. Similarly, there were no differences among the groups in terms of embryo development parameters. Moreover, implantation, pregnancy, and miscarriage rates with the three regimens were similar. However, the cost of rFSH was greater than that of the other protocols.

Conclusion(s): This study suggests that in the GnRH agonist protocol the three different gonadotropin regimens evaluated herein are equally effective. Protocols using HP-hMG would appear to be the best in terms of costeffectiveness in an oocyte donation program.

KeyWords: Cost minimization, embryo quality, IVF outcome, menotropin, recombinant FSH, oocyte donation, oocyte quality, ovarian stimulation