Ovarian stimulation protocols based on follicle-stimulating hormone glycosylation pattern: impact on oocyte quality and clinical outcome

Objective

To evaluate the impact of follicle-stimulating hormone (FSH) with different glycosylation patterns on oocyte quality and clinical outcomes in an in vitro fertilization (IVF) treatment program.

Design

Prospective randomized, open-label, clinical study.

Setting

Assisted reproduction center.

Patient(s)

One hundred eighty-eight infertile couples undergoing assisted fertilization treatment.

Intervention(s)

All participants underwent a standard down-regulation with a gonadotropin-releasing hormone (GnRH) analogue. The patients were randomized into three groups: 63 patients received combined sequential acidic and less-acidic FSH, 65 patients received only less-acidic FSH (recombinant FSH), and 60 received only acidic FSH (human-derived FSH).

Main Outcome Measure(s)

Number of mature metaphase II oocytes, embryo quality, clinical pregnancy rates, and implantation rates.

Result(s)

The pregnancy and implantation rates were statistically significantly lower in the less-acidic recombinant FSH alone group than in the combined sequential acidic hFSH/less-acidic recombinant FSH, and acidic hFSH alone groups (33.3%, 43.5%, 39% and 17.3%, 24.5%, 20.4%, respectively). Metaphase II oocytes and grade 1 embryos were statistically significantly higher in favor of the combined sequential acidic hFSH/less-acidic recombinant FSH group compared with the less-acidic recombinant FSH alone group.

Conclusion(s)

The glycosylation patterns of the two types of FSH implemented for ovarian stimulation have different impacts on oocyte quality and clinical outcome. A sequential combined protocol using both acidic and less-acidic FSH for ovarian stimulation improves oocyte maturity and embryo cleavage, and increases pregnancy and implantation rates.

Key Words: Acidic human FSH, embryo, FSH glycosylation, less acidic recombinant FSH, oocyte, ovarian stimulation