Comparing clinical outcomes of rFSH versus rFSH+HP-hMG in women undergoing in vitro fertilization-embryo transfer in real‑world practice: a retrospective study

Abstract Clinical outcomes of combining recombinant follicle-stimulating hormone (rFSH) with highly purified human menopausal gonadotropin (HP-hMG) versus rFSH alone were compared in patients undergoing in vitro fertilization in a real-world setting. This retrospective cohort study analyzed patients who underwent ovarian stimulation with rFSH or rFSH + HP-hMG following a gonadotropin-releasing hormone antagonist protocol, followed by fresh or frozen embryo transfer (ET) at two centers in Korea. A total of 1,028 women were included: 329 underwent fresh ET (rFSH: n = 78; rFSH + HP-hMG: n = 251) and 699 underwent frozen ET (rFSH: n = 250; rFSH + HP-hMG: n = 449). Across both fresh and frozen ET group, patients receiving rFSH + HP-hMG were older and had lower anti-Müllerian hormone levels and antral follicle counts. Despite fewer oocytes retrieved in rFSH + HP-hMG group (fresh: 9.5 vs. 11.0; frozen: 16.3 vs. 20.6, both p < 0.05), metaphase II oocyte rates and clinical pregnancy rates were comparable (fresh: 44.6 vs. 43.6%; frozen: 58.4 vs. 56.8%, both p > 0.05). Notably, ovarian hyperstimulation syndrome incidence was significantly lower in rFSH + HP-hMG group among frozen ET patients (6.9 vs. 13.2%, p < 0.01). These findings suggest that rFSH + HP-hMG achieves comparable clinical outcomes to rFSH alone despite less favorable prognostic characteristics that could affect clinical outcome, supporting its role as a clinically acceptable alternative stimulation option in routine practice.