The goal of this retrospective study is to compare the effectiveness and cost-effectiveness of two mixed ovarian stimulation protocols in women undergoing in vitro fertilization (IVF).

The main questions it aims to answer are:

• Does the combination of follitropin delta + HP-hMG result in a higher number of utilizable blastocysts per treatment cycle compared to follitropin alfa + HP-hMG?
• Does the follitropin delta based mixed protocol reduce total gonadotropin dose and cost per usable blastocyst while maintaining or improving pregnancy outcomes?

Researchers will compare follitropin alfa (Gonal-F®) + HP-hMG (Menopur®) with follitropin delta (Rekovelle®) + HP-hMG (Menopur®) to determine which protocol improves ovarian response, embryology outcomes, pregnancy rates, and overall treatment cost-efficiency.

Inclusion Criteria:

• Women between 18-45 years included
• First ovarian stimulation cycle only
• Patients who used mixed protocols combining menotropin and follitropin alfa or delta
• Patients whose Rekovelle doses were prescribed using the algorithm based on AMH and weight.

Exclusion Criteria:

• Patients who did not follow the algorithm to determine follitropin delta dosing and who required dose adjustments during the stimulation
• Patients who took concomitant treatment, such as corticosteroids, low molecular weight heparin, nonsteroidal anti-inflammatory drugs, recombinant LH or intra-vaginal vasodilators
• Oocytes donation or fertility preservation cycles

Women who underwent their first IVF cycle between 2018 and 2024 at the ovo clinic