Ovarian stimulation with human and recombinant gonadotropin – comparison of in vitro fertilization efficiency with use of time-lapse monitoring

BACKGROUND Achieving pregnancy by in vitro fertilization (IVF) treatment depends on many factors, including the ovaries' capacity and the efficiency of ovarian stimulation. The aim of this study was to assess the influence of ovarian stimulation with human and recombinant gonadotropin, as well as specific hormonal parameters, on the effectiveness of IVF and the dynamics of embryonic development. METHODS The study involved 221 women aged 25-35 years in whom intracytoplasmic sperm injection was performed. The ovarian stimulation was carried out according to the short protocol: injections of gonadotropin-releasing hormone analogue were followed by human (hFSH) and recombinant (rFSH) follicle-stimulating hormone administration. The growth of embryos was monitored with a time-lapse system. Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) were measured before ovarian stimulation, and levels of estradiol were assessed on the day of administration of recombinant chorionic gonadotropin. RESULTS Pregnancy was achieved in 77 women (group A) - 42 (54.55 %) of them were stimulated with hFSH and 35 (45.45 %) were stimulated with rFSH. Among the 144 women in whom pregnancy was not achieved (group B), hFSH was administered to 73 (50.69 %) women and rFSH to 71 (49.31 %) women. In both groups subsequent embryo development stages were usually noted earlier after hFSH stimulation than after rFSH stimulation. The average values of AMH, estradiol, and estradiol per >17 mm follicle were higher in group A; in turn, FSH and LH mean levels were higher in group B. ROC curve analysis showed no statistically significant differences between accuracy of using FSH and AMH levels to predict pregnancy after IVF. CONCLUSIONS The kind of gonadotropin applied to stimulate ovaries impacts the dynamics of embryo development - in women stimulated with hFSH, subsequent development stages were usually observed earlier than in women treated with rFSH; however, there was no statistically significant difference in pregnancy rates between women who were hFSH stimulated and those who were rFSH stimulated. The mean estradiol level was higher in women who achieved pregnancy than in women in whom pregnancy was not achieved AMH and FSH have the greater impact on achieving pregnancy than other hormones, and the value of AMH and FSH in predicting pregnancy is similar.