title: Addition of highly purified HMG after corifollitropin alfa in antagonist-treated poor ovarian responders: a pilot study.
abstract: OBJECTIVE
  Will sequential administration of highly purified (hp)-HMG after corifollitropin alfa in a GnRH antagonist protocol benefit women with poor ovarian response according to the Bologna criteria?
  
  
  CONCLUSIONS
  Corifollitropin alfa followed by hp-HMG in a GnRH antagonist protocol results in very promising pregnancy rates, albeit only in young (<40 years old) poor ovarian responders fulfilling the Bologna criteria.
  
  
  BACKGROUND
  Poor ovarian responders fulfilling the Bologna criteria have a very poor prognosis in terms of successful IVF outcome. Although a recent study demonstrated low pregnancy rates in this group of patients after treatment with corifollitropin alfa followed by recombinant FSH in a GnRH antagonist protocol, previous studies showed that the addition of LH activity in 36- to 39-year-old women significantly increases implantation rates.
  
  
  METHODS
  In this retrospective pilot study, we included poor ovarian responders fulfilling the Bologna criteria treated with a completely novel protocol, with corifollitropin alfa followed by hp-HMG in a GnRH antagonist setting. Overall, 51 patients were treated within a period of 1 year (August 2011-August 2012).
  
  
  METHODS
  Patients received 150 μg corifollitropin alfa on second day of the menstrual cycle followed by a fixed daily dose of 0.25 mg of GnRH antagonist on Day 7 of the cycle onwards. On the ninth day of the cycle, a daily fixed dose of 300 IU hp-HMG was administered until the day of ovulation triggering. The primary outcome was ongoing pregnancy rate per patient.
  
  
  RESULTS
  Among 47 eligible women, 29 patients were <40 years old and 18 patients were ≥ 40 years old. No differences were observed in endocrine profile, number of cycles with oocyte retrieval (66 versus 67%) and cycles with embryo transfer (62 versus 61%) in women <40 versus ≥ 40 years old, respectively. However, 8 of the 29 women <40 years old had an ongoing pregnancy (28%) compared with 0 of 18 patients who were ≥ 40 years of age (P = 0.017).
  
  
  CONCLUSIONS
  Owing to the specific retrospective study design, bias cannot be ruled out and these results should not be extrapolated to other treatment protocols for poor ovarian responders. Therefore, caution should be taken when interpreting the results.
  
  
  CONCLUSIONS
  The promising results from this pilot study of corifollitropin alfa followed by hp-HMG stimulation indicate a potential beneficial effect in young poor ovarian responders fulfilling the Bologna criteria. The data provide the rationale for performing a randomized controlled trial to determine if there is sound evidence for a clinical introduction of this protocol.
  
  
  BACKGROUND
  No conflicts of interest to declare. No specific funding was received for this study.
authors: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. n.polyzos@gmail.com
authors: N P
authors: NP
authors: Polyzos
authors: M
authors: M
authors: De Vos
authors: R
authors: R
authors: Corona
authors: V
authors: V
authors: Vloeberghs
authors: C
authors: C
authors: Ortega-Hrepich
authors: D
authors: D
authors: Stoop
authors: H
authors: H
authors: Tournaye
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D043373:Follicle Stimulating Hormone, Human / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006801:Humans; D007986:Luteinizing Hormone / Q000627:therapeutic use; D008596:Menotropins / Q000627:therapeutic use*; D010053:Ovary / Q000378:metabolism*; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000627:therapeutic use; D027724:Reproductive Techniques, Assisted / Q000592:standards; D012189:Retrospective Studies
chemical_list: D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; C437186:follicle stimulating hormone, human, with HCG C-terminal peptide; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone