Comparison of outcomes fromcontrolled ovarian hyperstimulation (coh) cycles using human menopausal gonadotropins (hmg) versus dilute human chorionic gonadotropins (dhcg)

To compare ART cycle outcomes based on source of LH activity in mixed COH protocols Single center retrospective cohort study evaluating all ‘mixed protocol’ (using both FSH and LH receptor stimulation) COH cycles with planned egg retrieval, carried out from October 2022 to January 2023, during the hMG (menopur) shortage. The default protocol at our center uses hMG for LH activity and during this time, dhCG was substituted only for those patients without access, hence providing a native experiment. Outcomes were evaluated per retrieval and included gonadotropin doses, oocytes retrieved, oocyte maturity, positive serum hCG, biochemical and clinical pregnancy rates. These were compared using independent sample t-tests and Mann-Whitney U tests, as appropriate. Generalized estimating equation modeling was used to adjust for patient age, antral follicle count (AFC), anti-Mullerian hormone (AMH), and number of prior IVF cycles. 740 dhCG + FSH cycles were compared to 3,056 hMG + FSH cycles. The groups were similar in BMI, infertility diagnosis, baseline FSH, and gravidity. Patients using dhCG were younger (35.3 years vs 36.1, p=<0.001), with fewer prior IVF cycles (0.88 vs 1.2, p=<0.001), and higher AMH (3.2 vs 2.9, p=0.016) and higher AFC (16.7 vs 14.5, p=0<0.001). The dhCG + FSH group had a higher total number of oocytes retrieved (17.9 vs 15.0, p=<0.001), and number of M2 oocytes (12.3 vs 10.0, p=<0.001). These differences remained significant after adjustment. No difference was noted in duration of stimulation (13.97 vs 14.03d, p=0.51), number of M1 oocytes retrieved, rate of positive serum hCG per fresh transfer, biochemical pregnancy rate, and clinical pregnancy rate. An hMG shortage requiring replacement with dHCG for mixed COH ART protocols in a subset of patients provided a naturally-occurring opportunity to compare these medications. Patients stimulated with dhCG had a similar clinical pregnancy rate and more total oocytes and M2 oocytes retrieved, even after adjusting for confounding variables.