Comparison of highly purified urinary versus recombinant FSH: Effect on ART outcomes in polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a common cause of ovulatory disorders and infertility with high LH to FSH ratio. In order to prevent further increase of LH and follicle atresia, different regimens for ovulation induction have been recommended using FSH alone. Objective: This study was performed in PCOS patients to compare ART outcomes in cycles induced by FSH alone, using either recombinant or urinary products. Materials and Methods: In a randomized trial, from 623 patients who underwent down regulation with GnRH analogue in a long protocol, 160 PCOS patients were randomly divided into two groups of 80. Group A received 150 IU/d recombinant FSH (Gonal-F) and group B 150 IU/d urinary FSH (Fostimon). Results: 33 cases (41.2%) in group A and 36 (45%) in group B achieved clinical pregnancy, which was not significantly different (p=0.67). Total number of oocytes retrieved (13.03 +/- 5.56 vs. 14.17 +/- 4.89, p=0.17), quality and number of embryos (7.42 +/- 3.35 vs. 7.63 +/- 3.28, p=0.68) and OHSS rate were similar in group A compared to group B. Endometrial thickness which was 9.66 +/- 1.67 mm in group A and 10.36 +/- 1.35 mm in group B, showed a significant difference (p=0.004). Conclusion: It seems that in PCOS patients, both pure FSH products used for controlled ovarian hyperstimulation have similar effects on ART outcome and can be used according to availability and patient acceptance without significant difference.