Michael Toni J F, Kirubakaran Ranita, Parab Tanay, Wang Rui, Grosser Mark, Vollenhoven Beverley J, Smith Vinayak, Stocker Sophie L
School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Department of Pharmacy, Seberang Jaya Hospital, Seberang Perai, Penang, Malaysia.
Clin Pharmacol Ther. 2025 Oct;118(4):790-802. doi: 10.1002/cpt.70014. Epub 2025 Jul 31.
Understanding the variability in ovarian response following administration of follicle-stimulating hormone medications in women undergoing in vitro fertilization may help inform prescribing decisions. A systematic review was conducted to compare the number of retrieved oocytes and fertility outcomes following the administration of different follicle-stimulating hormone medications. Databases were searched from inception to November 2024, including studies that compared two follicle-stimulating hormone medications, including follitropin alfa, follitropin beta, follitropin delta, and urofollitropin. Meta-analyses were performed in random effects models with the restricted maximum likelihood method. From 3867 identified articles, 26 (12613 participants) were included. More oocytes were retrieved with follitropin alfa compared to beta (mean difference 0.64, 95% CI 0.09-1.19). Compared to follitropin delta, more oocytes were retrieved with follitropin alfa and beta (1.38, 95% CI 0.09-2.67, and 1.40, 95% CI 0.41-2.39, respectively); however, higher total doses of follitropin alfa and beta were administered (199.29 IU, 95% CI 43.15-355.43 and 181.08 IU, 95% CI 55.67-306.49, respectively), and the risk of hyperstimulation increased (risk ratios 1.42, 95% CI 1.04-1.96 and 1.75, 95% CI 1.15-2.70, respectively). More oocytes were retrieved with urofollitropin compared to follitropin beta (1.12, 95% CI -1.63 to -0.62), with higher total doses of urofollitropin administered (782.32 IU, 95% CI -1493.79 to -70.85). Variability in ovarian response and hyperstimulation rates across the medications decreased when similar total doses were administered. Fertilization, pregnancy, and live birth rates were similar across the medications, despite differences in the number of retrieved oocytes. Additional research is required to evaluate oocyte quality across follicle-stimulating hormone medications.
了解接受体外受精的女性在使用促卵泡激素药物后卵巢反应的变异性，可能有助于指导用药决策。本研究进行了一项系统综述，比较使用不同促卵泡激素药物后回收的卵母细胞数量和生育结局。检索了从数据库建立至2024年11月的文献，纳入比较两种促卵泡激素药物的研究，这些药物包括重组促卵泡素α、重组促卵泡素β、重组促卵泡素δ和尿促卵泡素。采用限制最大似然法在随机效应模型中进行荟萃分析。从3867篇检索到的文章中，纳入了26篇（12613名参与者）。与重组促卵泡素β相比，重组促卵泡素α回收的卵母细胞更多（平均差异0.64，95%可信区间0.09 - 1.19）。与重组促卵泡素δ相比，重组促卵泡素α和重组促卵泡素β回收的卵母细胞更多（分别为1.38，95%可信区间0.09 - 2.67和1.40，95%可信区间0.41 - 2.39）；然而，重组促卵泡素α和重组促卵泡素β的总给药剂量更高（分别为199.29IU，95%可信区间43.15 - 355.43和181.08IU，95%可信区间55.67 - 306.49），且卵巢过度刺激综合征的风险增加（风险比分别为1.42，95%可信区间1.04 - 1.96和1.75，95%可信区间1.15 - 2.70）。与重组促卵泡素β相比，尿促卵泡素回收的卵母细胞更多（1.12，95%可信区间 - 1.63至 - 0.62），尿促卵泡素的总给药剂量更高（782.32IU，95%可信区间 - 1493.79至 - 70.85）。当给予相似的总剂量时，不同药物之间卵巢反应和卵巢过度刺激综合征发生率的变异性降低。尽管回收的卵母细胞数量存在差异，但不同药物的受精率、妊娠率和活产率相似。需要进一步研究来评估不同促卵泡激素药物的卵母细胞质量。
