FSH priming and hormonal modulation of oocyte competence in in-vitro maturation for infertility treatment: A systematic review and meta-analysis

Krystal Baysan Lin¹Yungchen Chien¹Jung-Hsiu Hou^1,2Yen-Chen Wu^1,3Pin Lun Lin¹Li-Ting Chien⁴Chi-Huang Chen^1,5*

• ¹Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei City, Taiwan
• ²Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei City, Taiwan
• ³Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan, Taipei City, Taiwan
• ⁴Taipei Medical University Library, Taipei City, Taiwan
• ⁵Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

Background: Does follicle-stimulating hormone priming improve reproductive outcomes in women undergoing in vitro maturation treatment for infertility? Follicle-stimulating hormone (FSH) is a key endocrine regulator of oocyte folliculogenesis, and is crucial for granulosa-oocyte communication and cytoplasmic maturation. In-vitro maturation (IVM) offers a lower risk when compared to conventional in-vitro fertilization ovarian stimulation; however, wide-spread clinical adoption is limited by variable success rates and protocol heterogeneity. In regards to optimization strategies, FSH priming has been proposed to enhance oocyte competence, but its impact remains debatable. Objective: To evaluate the effects of FSH priming on oocyte maturation and reproductive potential in IVM cycles for infertile women. Methods: Employing PRISMA guidelines, we systematically searched Pubmed, Cochrane Library, Embase and Web of Science for randomized controlled trials comparing FSH-primed versus non-primed IVM cycles in infertile women. Primary outcome was oocyte maturation rate, while secondary outcomes included fertilization rate, cleavage rate, pregnancy rate, and implantation rate. Data pooled used random-effects models, with heterogeneity assessed by I2 statistic. Results: Six randomized controlled trials comprising of 497 women were analyzed. FSH priming was associated with a statistically significant increase in oocyte maturation rate [OR 1.24(95% CI, 1.05 -1.45)] when compared to the non-stimulated group. However, pooled analysis showed no significant differences in fertilization rate or clinical pregnancy rate between groups. Conclusion: FSH priming has been shown to enhance oocyte maturation rate in in-vitro maturation cycles. However, current evidence shows that gonadotropin does not significantly improve fertilization or pregnancy outcomes.