title: Sequential protocol with urinary-FSH/recombinant-FSH versus standard protocol with recombinant-FSH in women of advanced age undergoing IVF.
abstract: A stimulation protocol mimicking the physiological pattern of FSH release may improve IVF outcome in women of advanced age. Urinary-FSH delivers a wider range of isoforms including the most acidic produced during the early follicular phase when oestradiol level is low, a common condition in women of advanced reproductive age. We hypothesized that a stimulation protocol using urinary-FSH during the early follicular phase and then shifting toward recombinant-FSH may improve oocyte quality and pregnancy rate in 35-40 years old patients in IVF program. A retrospective study was performed: after a standard down-regulation with GnRH-analogue, 115 women underwent stimulation with urinary-FSH for 6 days according to a step-down approach and then shifting to recombinant-FSH (group A), 115 women underwent a stimulation protocol with only recombinant-FSH (group B). Days of stimulation were lower in group A than in group B, a higher proportion of MII oocytes and of grade 1 embryos, higher implantation rate and pregnancy rate were observed in group A versus group B. We conclude that a sequential protocol using urinary-FSH in the early days of stimulation and subsequently recombinant-FSH may improve the IVF outcome in patients of advanced reproductive age.
authors.affiliation: Outpatient Fertility Clinic, Second University of Naples , Naples , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Colacurci
authors.forename: Francesca
authors.initials: F
authors.lastname: Caprio
authors.forename: Eugenio
authors.initials: E
authors.lastname: La Verde
authors.forename: Carlo
authors.initials: C
authors.lastname: Trotta
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ianniello
authors.forename: Daniela
authors.initials: D
authors.lastname: Mele
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Franciscis
mesh_terms: D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D006801:Humans; D009865:Oocytes / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D005640:Follicle Stimulating Hormone
keywords: ART; Advanced reproductive age; FSH; infertility; oocyte quality