Document Detail

WITHDRAWN: Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction cycles.
MedLine Citation:
PMID:  17636708     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Until recently, the main source of exogenous follicle stimulating hormone (FSH) for therapeutic use in infertility had been the urine of postmenopausal women. New developments have resulted in the production of FSH in vitro by recombinant DNA technology. The extremely high purity and batch-to-batch consistency of recombinant FSH (rFSH) make it an attractive alternative to urinary FSH (uFSH).
OBJECTIVES: To conduct a systematic review and meta-analysis of randomised trials comparing the effectiveness of rFSH with uFSH in ovarian stimulation protocols in in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) treatment cycles.
SEARCH STRATEGY: Search strategies included on-line searching of the MEDLINE and EMBASE databases from 1985 to 1999, hand searching of bibliographies of relevant publications and reviews and abstracts of scientific meetings, peer consultation and contacting the pharmaceutical companies that manufacture the gonadotropins under consideration.
SELECTION CRITERIA: Randomised trials comparing rFSH with uFSH for ovarian stimulation in IVF or ICSI treatment for infertility.
DATA COLLECTION AND ANALYSIS: The main outcome measure was clinical pregnancy per cycle started. Also considered were clinical pregnancy per cycle reaching oocyte retrieval and per cycle reaching embryo transfer (ET), ongoing pregnancy per cycle started, spontaneous abortion, multiple pregnancy, ovarian hyperstimulation syndrome (OHSS), number of follicles and serum estradiol level on the day of human chorionic gonadotropin administration day, total dose of FSH, and number of oocytes retrieved. Common odds ratios (OR) and risk differences for rFSH relative to uFSH were calculated after testing for homogeneity of treatment effect across all trials. The fixed effects model was used, unless significant heterogeneity was present, in which case the random effects model was used.
MAIN RESULTS: The overall odds ratio for clinical pregnancy per cycle started was 1.21 (95% confidence limits (CL) 1.04,1.42) for rFSH compared to uFSH. The risk difference was a 3.7% (0.8,6.7) absolute increase in clinical pregnancy rate with rFSH. The OR for ongoing pregnancy per cycle started was 1.29 (1.08,1.54). There was no significant difference between rFSH and uFSH in the rates of spontaneous abortion, multiple pregnancy or OHSS. The total dose of FSH was lower by 406 (185,627) IU with rFSH, but there was no significant difference in the number of follicles or serum estradiol on hCG day or in the number of oocytes retrieved.
AUTHORS' CONCLUSIONS: This review has demonstrated a statistically significant increase in clinical pregnancy rate with rFSH compared to uFSH, when used for ovarian stimulation in assisted reproduction. This benefit was observed only in standard IVF cycles and not in cycles in which ICSI was used.
S Daya; J Gunby
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-07-18
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2006  
Date Detail:
Created Date:  2007-07-19     Completed Date:  2007-10-18     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD002810     Citation Subset:  IM    
Department of Obstetrics & Gynecology, Clinical Epidemiology & Biostatistics, 2407 Carrington Place, Oakville, Ontario, Canada, L6J 7R6.
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MeSH Terms
Fertilization in Vitro
Follicle Stimulating Hormone / therapeutic use*,  urine
Meta-Analysis as Topic
Ovulation Induction / methods*
Randomized Controlled Trials as Topic
Recombinant Proteins / therapeutic use
Sperm Injections, Intracytoplasmic
Reg. No./Substance:
0/Recombinant Proteins; 9002-68-0/Follicle Stimulating Hormone
Update Of:
Cochrane Database Syst Rev. 2000;(4):CD002810   [PMID:  11034767 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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