title: Intercycle variability of the ovarian response in patients undergoing repeated stimulation with corifollitropin alfa in a gonadotropin-releasing hormone antagonist protocol.
abstract: OBJECTIVE
  To determine whether individual subject variation in ovarian response between repeated cycles with the same ovarian stimulation protocol can be predicted.
  
  
  METHODS
  Retrospective data analysis.
  
  
  METHODS
  Multicenter, open-label, uncontrolled clinical trial.
  
  
  METHODS
  Women aged 18-39 from a phase 3, open-label, uncontrolled trial with complete data across all cycles (n = 176).
  
  
  METHODS
  Up to three cycles of a single injection of 150 μg corifollitropin alfa for 7 days, then daily recombinant FSH/hMG until three follicles reached ≥17 mm. Gonadotropin-releasing hormone antagonist from stimulation day 5 until day of hCG administration.
  
  
  METHODS
  Numbers of follicles ≥11 mm on day of hCG in cycles 1-3, transition in ovarian response type between cycles from low (0-<6), normal (6-<18), and high (≥18), and serum FSH concentrations and antral follicle count (AFC) at each cycle start.
  
  
  RESULTS
  The mean (SD) numbers of follicles ≥11 mm on day of hCG were 13.4 (6.2), 13.3 (5.4), and 13.8 (6.4) in cycles 1, 2 and 3, respectively. Between cycles 1 and 2, 11.9% switched from normal to low or high response, and 12.5% switched from low or high to normal response; 75.6% remained in the same category. Between cycles 2 and 3, 15.9% switched from normal to low or high response, and 10.2% switched from low or high to normal response; 73.9% remained in the same category. These shifts are symmetrical in nature, in that the percentage of subjects who shift from normal to low or high response is comparable to the percentage of subjects who shift from low or high to normal response. Baseline FSH and AFC did not significantly predict transition in ovarian response.
  
  
  CONCLUSIONS
  The variability in ovarian responses between repeated cycles using the same protocol was not explained by baseline FSH and AFC.
  
  
  BACKGROUND
  NCT00696878 Protocol P05714.
authors.affiliation: Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Monash IVF, Clayton, Victoria, Australia. Electronic address: lrombauts@monashivf.com.
authors.forename: Luk
authors.initials: L
authors.lastname: Rombauts
authors.affiliation: Department of Obstetrics/Gynecology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Cornelis B
authors.initials: CB
authors.lastname: Lambalk
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Askan
authors.initials: A
authors.lastname: Schultze-Mosgau
authors.affiliation: MSD Oss N.V., Oss, the Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van Kuijk
authors.affiliation: MSD Oss N.V., Oss, the Netherlands.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verweij
authors.affiliation: Merck & Co., Inc., Kenilworth, New Jersey.
authors.forename: Davis
authors.initials: D
authors.lastname: Gates
authors.affiliation: Merck & Co., Inc., Kenilworth, New Jersey.
authors.forename: Keith
authors.initials: K
authors.lastname: Gordon
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Griesinger
mesh_terms: D000328:Adult; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007206:Individuality; D007247:Infertility, Female / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008597:Menstrual Cycle / Q000187:drug effects / Q000502:physiology*; D054315:Oocyte Retrieval / Q000379:methods; D010053:Ovary / Q000187:drug effects / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D043373:Follicle Stimulating Hormone, Human; D006727:Hormone Antagonists; C437186:follicle stimulating hormone, human, with HCG C-terminal peptide; D007987:Gonadotropin-Releasing Hormone
keywords: Corifollitropin alfa; GnRH antagonist; controlled ovarian stimulation; ovarian response; repeated ovarian stimulation