A randomized assessor-blind trial comparing highly purified hMG and recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer

Capsule:
A randomized, assessor-blind, multicenter trial with compulsory single-blastocyst transfer documented that highly purified hMG is noninferior to rFSH regarding ongoing pregnancy in GnRH antagonist cycles.

Authors:
Paul Devroey, M.D., Ph.D., Antonio Pellicer, M.D., Anders Nyboe Andersen, M.D., Joan-Carles Arce, M.D., Ph.D., Menopur in GnRH Antagonist Cycles with Single Embryo Transfer (MEGASET) Trial Group
Volume 97, Issue 3 , Pages 561-571, March 2012

Objective:
To compare the efficacy and safety of highly purified menotropin (hphMG) and recombinant FSH (rFSH) for controlled ovarian stimulation in a GnRH antagonist cycle with compulsory single-blastocyst transfer.

Design:
Randomized, open-label, assessor-blind, parallel groups, multicenter, noninferiority trial.

Setting:
Twenty-five infertility centers in seven countries.

Patient(s):
Seven hundred forty-nine women.

Intervention(s):
Controlled ovarian stimulation with hphMG or rFSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer on day 5 in one fresh or subsequent frozen blastocyst replacement in natural cycles initiated within 1 year of each patient’s start of treatment.

Main Outcome Measure(s):
Ongoing pregnancy (primary end point) and live birth rates, as well as pharmacodynamic parameters.

Result(s):
The ongoing pregnancy rate after a fresh cycle was 30% with hphMG versus 27% with rFSH for the per-protocol (PP) population and 29% versus 27% for the intention-to-treat (ITT) population. Noninferiority of hphMG compared to rFSH was established. Considering frozen cycles initiated within 1 year, the cumulative live birth rate for a single stimulation cycle was 40% and 38% for women treated with hphMG and rFSH, respectively (both PP and ITT). Significant differences in pharmacodynamic end points were found between the two gonadotropin preparations.

Conclusion(s):
Highly purified hMG is at least as effective as rFSH in GnRH antagonist cycles with compulsory single-blastocyst transfer.

Clinical Trial Registration Number:
NCT00884221.

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