JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):214
Poster Presentation
29th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263869
P-202. Rethinking Mixed Protocols in IVF: What Happened When Follitropin Delta Met Menotropin
Oscar Barbosa Duarte Filho1, Marcelo Welker Sapojkin Rossine1, João Dias Junior2, Carlos Roberto Izzo2, Maria do Carmo Borges de Souza3, Emerson Barchi Cordts4, Amanda Setti5, Maite Del Collado6, Daniela Braga6, Edson Borges Jr7, Nathalia Reggi Reis Silva Malandrino1, Carolina Leite Kowes1, Michelle Caroline Teixeira Nagai1, Marcelo Marinho de Souza3, Brenda Maria Loureiro de Melo3, Thaisa Damasceno3, Caio Parente Barbosa4, Luiz Fernando Henrique2, Ivan Henrique Yoshida4, Georges Fassolas2, Gustavo Maciel2, Roberto De Azevedo Antunes3
1 VidaBemVinda- FertGroup - São Paulo – SP – Brasil
2 Originare Medicina Reprodutiva - São Paulo – SP- Brasil
3 Fertipraxis - Centro de Reprodução Humana - Rio de Janeiro – RJ -Brasil
4 Instituto Ideia Fértil de Saúde Reprodutiva - São Paulo – SP – Brasil
5 Associação Instituto Sapientiae -São Paulo – SP – Brasil
6 Science For Everymind - São Paulo – SP -Brasil
7 Fertility Medical Group / FertGroup - São Paulo – SP- Brasil
Objective: Mixed protocols combining FSH and menotropin are commonly used in clinical practice, based on the presumed benefit of added LH activity. This study aimed to evaluate whether adding menotropin to follitropin delta (FD) in general IVF population improves outcomes compared to FSH monotherapy.
Methods: This retrospective multicenter cohort study analyzed 286 cycles using FD monotherapy (FSH-ONLY group) and 1,379 cycles using a combination of FD and menotropin (MIXED group), conducted between 2018 and 2023. The primary outcome was the number of mature (MII) oocytes retrieved. Secondary outcomes included follicular output rate (FORT), oocyte recovery rate, MII rate, as well as laboratory and cumulative clinical outcomes (up to the fourth embryo transfer). Cycles with male factor, oocyte cryopreservation and ovum donation or reception were excluded. Propensity score matching (PSM) was performed at a 1:2 ratio based on antral follicle count and female age, yielding 286 FSH-ONLY and 572 MIXED cycles after matching, for comparison of COS and laboratory outcomes. For ploidy and clinical outcomes, additional analyses were conducted exclusively in cases undergoing PGT-A. A total of 77 cases were successfully matched to 541 controls, with no exclusions from the final analysis. A general linear model was employed to evaluate the association between COS protocols and the dependent outcomes, with adjustments for potential confounding variables.
Results: After the PSM, the mean age and AFC were 35.10±0.43 years and 16.13±0.59 in the MIXED group, and 34.97±0.52 years and 16.97±0.75 in the FSH-ONLY group, with no statistically significant differences observed between the groups. Additionally, the average total dose of gonadotropins was 103.15 mcg of FD in the FSH-only, and 103.16 mcg of FD plus 1,143.46 IU of hMG in the MIXED groups. No significant differences were observed between the FSH-ONLY and MIXED groups in the number of oocytes (13.7±2.8 vs. 12.2±20.9; p=0.566), MII (10.64±2.2 vs. 9.23±0.8; p=0.505), oocyte yield (97.8 4.4% vs. 92.6±1.6%; p=0.211), or MII rate (78.1±6.4% vs. 79.3±2.2%; p=0.838). However, a significant reduction in the FORT was observed in the MIXED compared to the FSH-ONLY group (52.5±4.1% vs. 78.1±11.4%; p=0.0178). Among laboratory outcomes, no significant differences were found between groups in fertilization (74.8±2.4% vs. 76.0±1.9%; p=0.60), total blastocyst formation (62.3±3.5% vs. 59.0±2.7%; p=0.342), top-quality blastocyst (40.9±3.0% vs. 38.2±2.4%; p=0.455), or euploid blastocyst rate (45.7±4.9% vs. 43.7±4.2%; p=0.662). Similarly, no significant differences were observed in cumulative clinical outcomes between the FSH-ONLY and MIXED groups, including positive beta-hCG (68.1±9.0% vs. 69.5±6.5%; p=0.868), clinical pregnancy (67. ±9.0% vs. 64.9±6.9%; p=0.786), and live birth rates (55.5±14.5% vs. 46.4±9.4%; p=0.496).
Conclusion: The addition of menotropin to FD did not improve laboratory or clinical outcomes and was associated with a lower FORT follicular output rate in the general IVF population.