HP-hMG stimulation reduces OHSS risk in high responder patients

HP-hMG stimulation reduces OHSS risk in high responder patients | Image Credit: © Orawan - © Orawan - stock.adobe.com.

There is a significant association between highly purified human menotropin (HP-hMG) stimulation and reduced overall and early ovarian hyperstimulation syndrome (OHSS) compared to recombinant follicle stimulating hormone (rFSH), without mediation from oocyte yield, according to a recent study published in Fertility and Sterility.¹

Prior data has indicated a reduced cost to achieving live birth in women with serum antimüllerian hormone of at least 5 ng/mL when using HP-hMG vs rFSH.² The cost of these methods was compared in 619 women during a Gonadotropin Releasing Hormone (GnRH) antagonist assisted reproductive cycle.

A first-transfer efficacy of 54.5% was reported among patients receiving HP-hMG vs 48% among those receiving rFSH. This indicated a lower average cost to achieve live birth from the former method.²

Investigators conducted the MEGASET-HR study to compare OHSS risk in high responder patients following ovarian stimulation using HP-hMG vs rFSH.¹ The multicenter prospective trial included women aged 21 to 35 years with anti-Müllerian hormone (AMH) of 5 ng/mL or higher.

Participants were randomized 1:1 to receive either 150 IU HP-hMG or rFSH. Treatment was administered in a GnRH antagonist cycle, with doses adjusted as necessary starting day 6.¹

Oocyte maturation was triggered by the GnRH antagonist in patients with high OHSS risk, defined as over 30 follicles measuring at least 12 mm or serum estradiol of at least 5000 pg/mL. In patients without oocyte maturation, human chorionic gonadotropin (hCG) was used. Single blastocyst transfer occurred during hCG-triggered cycles.¹

Golan’s criteria was used to classify OHSS, with early OHSS considered onset at 9 days or under while late OHSS was defined as onset after 9 days. The Agresti-Min method was used to generate 95% exact confidence intervals of summaries based on oocytes retrieved.¹

Similar live birth rates were reported between groups following fresh and frozen transfer. However, HP-hMG-treated patients had significantly reduced overall OHSS, early OHSS, and number of oocytes retrieved when compared to rFSH-treated patients.¹

Of patients reporting early OHSS, the mean weight was greater in those treated with Hp-hMG vs rFSH. No other significant variations in baseline characteristics were observed between groups.¹

Similar serum estradiol levels were reported between groups at the end of stimulation. Early OHSS rates differed in HP-hMG treated patients based on the number of oocytes retrieved, at 2.9% in those with 1 to 5 oocytes retrieved, 4.1% in those with 6 to 10 oocytes, 5.3% in those with 11 to 15 oocytes, and 9.7% in those with 16 to 22 oocytes.¹

In rFSH-treated patients, these rates were 0%, 0%, 7.1%, and 15.5%, respectively. For patients with over 25 oocytes retrieved, rFSH-treated patients were significantly more likely to present with early OHSS than HP-hMG treated patients, at 32.4% and 8.3%, respectively.¹

When adjusting for oocytes yielded, a 0.45-fold change in early OHSS risk was reported among HP-hMG patients when compared to rFSH-treated patients, indicating a significant reduction in overall and early OHSS rates among these individuals. Investigators concluded safety considerations could “drive improved protocol individualization based on gonadotropin type.”¹

References

1. Foulk RA, Slater CC, Karande V, et al. Impact of gonadotropin selection on risk of ovarian hyperstimulation syndrome (OHSS) in predicted high responders undergoing ovarian stimulation: A MEGASET HR trial analysis. Fertility and Sterility. 2024;122(4):64-65.
2. Robins JC, Khair AF, Widra EA, et al. Economic evaluation of highly purified human menotropin or recombinant follicle-stimulating hormone for controlled ovarian stimulation in high-responder patients: analysis of the Menopur in Gonadotropin-releasing Hormone Antagonist Single Embryo Transfer–High Responder (MEGASET-HR) trial. 2020;1(3):257-263.