FSH replaced by low-dose hCG in the late follicular phase versus continued FSH for assisted reproductive techniques

• Published in: Cochrane database of systematic reviews 2013-03, Vol.2013 (3), p.CD010042
• Main Authors: Martins, Wellington P, Vieira, Andrea D D, Figueiredo, Jaqueline B P, Nastri, Carolina O
• Format: Article
• Language: English
• Subjects: Abortion, Spontaneous - epidemiology; Chorionic Gonadotropin - administration & dosage; Chorionic Gonadotropin - adverse effects; Confidence Intervals; Drug Substitution; EVALUATION OF SUBFERTILITY TREATMENTS RELATING TO THE FEMALE PARTNER; Female; Fertility Agents, Female - administration & dosage; Fertility Agents, Female - adverse effects; Follicle Stimulating Hormone - administration & dosage; Follicular Phase - drug effects; Follicular Phase - physiology; Gynaecology; Humans; Live Birth; Pregnancy; Randomized Controlled Trials as Topic; Reproductive Techniques, Assisted
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD010042.pub2

During controlled ovarian hyperstimulation (COH) follicle-stimulating hormone (FSH) is frequently used for several days to achieve follicular development. FSH is a relatively expensive drug, substantially contributing to the total expenses of assisted reproductive techniques (ART). When follicles achieve a diameter greater than 10 mm they start expressing luteinising hormone (LH) receptors. At this point, FSH might be replaced by low-dose human chorionic gonadotropin (hCG), which is less expensive. In addition to cost reduction, replacing FSH by low-dose hCG has a theoretical potential to reduce the incidence of ovarian hyperstimulation syndrome (OHSS). To evaluate the effectiveness and safety of using low-dose hCG to replace FSH during the late follicular phase in women undergoing COH for assisted reproduction, compared to the use of a conventional COH protocol. We searched for randomised controlled trials (RCT) in electronic databases (Menstrual Disorders and Subfertility Group Specialized Register, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS), trials registers (ClinicalTrials.gov, Current Controlled Trials, World Health Organization International Clinical Trials Registry Platform), conference abstracts (ISI Web of knowledge), and grey literature (OpenGrey); additionally we handsearched the reference list of included studies and similar reviews. The last electronic search was performed in February 2013.. Only true RCTs comparing the replacement of FSH by low-dose hCG during late follicular phase of COH were considered eligible; quasi or pseudo-randomised trials were not included. Cross-over trials would be included only if data regarding the first treatment of each participant were available; trials that included the same participant more than once would be included only if each participant was always allocated to the same intervention and follow-up periods were the same in both/all arms, or if data regarding the first treatment of each participant were available. We excluded trials that sustained FSH after starting low-dose hCG and those that started FSH and low-dose hCG at the same time. Study eligibility, data extraction, and assessment of the risk of bias were performed independently by two review authors, and disagreements were solved by consulting a third review author. We corresponded with study investigators in order to solve any query, as required. The overall quality of the evidence was assessed in a GRADE summary of findings table. The