Evidence of Clinical Superioriy

From hMG to HP-hMG

IVF/ICSI cycles

• Multifollicular development by gonadotrophins is still an integral component for ovarian stimulation in IVF / ICSI cycles (Keck et al, 2005)

In The Market

VS

rec FSHhMG

!!

• In the 1990s, recombinant FSH was not directly compared to hMG

• It was compared to HP-FSH

• the relatively high price of rFSH has hampered its wide-spread clinical use (Sykes et al., 2001).

Gonadotrophins

• The technological developments of gonadotrophins over the last years have shown improvements in specific activity, purity, degradation and impurities (Bassett & Driebergen, 2005)

In the new millennium

There was no significant difference between hMG & recFSH regarding clinical pregnancy rate

Al-Inany et al, 2005

hMG (363/ 1453) vs. rFSH (324/ 1484)

(O.R = 1.20, 95% CI = 1.01 - 1.42;

P < 0.04)

Al-Inany et al., RBM Online, (2008)

Live birth rate

Observation• More than 2/3 of participants in hMG

arm in our meta-analysis used HP-hMG which could be the influencing factor to change the evidence

Al-Inany et al., RBM Online, 2008

HP-hMG (320/ 1176) vs. rFSH (279/ 1178)

( O.R = 1.21, 95% CI = 1.00 - 1.45)

Clinical Pregnancy Rate

(P = 0.05)

Ongoing Pregnancy/Live-birth Rate

HP-hMG (293/ 1176) vs. rFSH (258/ 1178)24.9% vs 21.9%

( O.R = 1.19, 95% CI = 0.98 - 1.44)(P = 0.08)

HP-hMG is preferred in IVF cycles due

to better live birth rate