Publication:

A comparative study of rFSH, HMG, and FSH-HMG stimulation protocols on embryo quality and outcomes across first and second IVF-ICSI cycles

Background Optimization of ovarian stimulation is crucial for improving oocyte quality, embryo development, and implantation outcomes in IVF/ICSI cycles. This study compared clinical and embryological results of three stimulation regimens recombinant FSH (rFSH), human menopausal gonadotropin (HMG), and a combined rFSH-HMG protocol-across two consecutive IVF/ICSI cycles to evaluate potential improvements over time.

Methods A retrospective analysis was conducted on 120 women who underwent two IVF/ICSI cycles between 2021 and 2024. Participants were grouped into rFSH (n=67), HMG (n=33), and rFSH-HMG (n=13). Stimulation characteristics and embryological outcomes, including oocyte retrieval, MII oocyte yield, fertilization, and blastocyst formation, were compared between cycles. Statistical analysis included t-tests, chi-square tests, Mann-Whitney U tests, and ROC curve analysis to determine predictive value for fertilization and blastocyst development.

Results Baseline demographics and hormonal parameters showed no significant differences between groups. In the second cycle, the rFSH group demonstrated significantly higher oocyte retrieval, MII oocyte yield, fertilization, and blastocyst formation (p<0.05). ROC analysis showed rFSH-HMG had the strongest predictive value for blastocyst formation (AUC=0.963), followed by HMG (0.880) and rFSH (0.774).

Conclusions Second-cycle IVF/ICSI outcomes improved across several embryological parameters, suggesting beneficial effects of prior stimulation or clinical adjustments. rFSH showed consistent improvement, while rFSH-HMG was the strongest predictor of blastocyst formation. Recognizing cycle-to-cycle dynamics may enhance individualized stimulation strategies and improve reproductive success.