Patterns of Use of Follitropin Delta in Brazilian Assisted Reproduction: Results of the Multicenter PURO Real World Study.

OBJECTIVE: To characterize prescription patterns, dosing, ovarian response, and reproductive outcomes associated with follitropin delta in routine Brazilian assisted reproduction practice. METHODS: This multicenter retrospective cohort study included five private IVF centers in Brazil. A total of 2,284 women aged 18-47 years treated with follitropin delta between April 2018 and December 2023 were included. Controlled ovarian stimulation was administered as monotherapy or in combination with other gonadotropins. Starting doses were determined using an AMH/weight-based algorithm or physician discretion. Outcomes assessed included protocol distribution, follitropin delta dosing, oocyte yield, number of blastocyst, ongoing pregnancy rate, and severe OHSS incidence. RESULTS: Protocol distribution was: algorithm-guided monotherapy, 1.9%; empirical monotherapy, 14.8%; delta plus menotropin, 75.2%; delta plus rFSH/LH, 5.0%; other combinations, 3.1%. Pituitary suppression was mainly achieved with GnRH antagonist (50.7%) or PPOS (43.4%). Final oocyte maturation was triggered with GnRH agonist (47.8%), hCG (10.9%), or dual trigger (41.3%). Among patients, 1,448 (63.4%) underwent autologous IVF/ICSI cycles, 705 (30.9%) oocyte cryopreservation, and 131 (5.7%) oocyte donation cycles. Overall, 2163 patients underwent oocyte pick-up with a mean±SD of 12.9±9.5 oocytes retrieved. Among IVF patients, 715 underwent at least one embryo transfer. Ongoing pregnancy rates across the first to fourth transfers were 50.3%, 42.4%, 24.5%, and 56.3%, respectively. Severe OHSS occurred in 0.14% of IVF patients. CONCLUSIONS: Follitropin delta was predominantly used in combination with menotropin and was associated with robust oocyte yield, favorable ongoing pregnancy rates, and low severe OHSS incidence, supporting its feasibility and safety in routine clinical practice.