A Patient Friendly Corifollitropin Alfa Protocol without Routine Pituitary Suppression in Normal Responders.
The release of corifollitropin alfa simplifies daily injections of short-acting recombinant follicular stimulating hormone (rFSH), and its widely-used protocol involves short-acting gonadotropins supplements and a fixed GnRH antagonist regimen, largely based on follicle size. In this study, the feasibility of corifollitropin alfa without routine pituitary suppression was evaluated. A total of 288 patients were stimulated by corifollitropin alfa on cycle day 3 following with routine serum hormone monitoring and follicle scanning every other day after 5 days of initial stimulation, and a GnRH antagonist (0.25 mg) was only used prophylactically when the luteinizing hormone (LH) was ≧ 6 IU/L (over half of the definitive LH surge). The incidence of premature LH surge (≧ 10 IU/L) was 2.4% (7/288) before the timely injection of a single GnRH antagonist, and the elevated LH level was dropped down from 11.9 IU/L to 2.2 IU/L after the suppression. Two hundred fifty-one patients did not need any antagonist (87.2% [251/288]) throughout the whole stimulation. No adverse effects were observed regarding oocyte competency (fertilization rate: 78%; blastocyst formation rate: 64%). The live birth rate per OPU cycle after the first cryotransfer was 56.3% (161/286), and the cumulative live birth rate per OPU cycle after cyrotransfers was 69.6% (199/286). Of patients who did and did not receive GnRH antagonist during stimulation, no significant difference existed in the cumulative live birth rates (78.4% vs. 68.3%, p = 0.25). The results demonstrated that the routine GnRH antagonist administration is not required in the corifollitropin-alfa cycles using a flexible and hormone-depended antagonist regimen, while the clinical outcome is not compromised. This finding reveals that the use of a GnRH antagonist only occasionally may be needed.
Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan (R.O.C).
Huai-Ling
HL
Wang
Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan (R.O.C).
Hsing-Hua
HH
Lai
Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan (R.O.C).
Tzu-Hsuan
TH
Chuang
Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan (R.O.C).
Yu-Wei
YW
Shih
Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan (R.O.C).
Shih-Chieh
SC
Huang
Stork Fertility Center, Stork Ladies Clinic, Hsinchu, Taiwan (R.O.C).
Meng-Ju
MJ
Lee
Department of Obstetrics and Gynecology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (R.O.C).
Shee-Uan
SU
Chen
D000328:Adult; D001723:Birth Rate; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage / Q000494:pharmacology*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D006080:Ovarian Follicle / Q000166:cytology / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D055815:Young Adult
D043373:Follicle Stimulating Hormone, Human; D006727:Hormone Antagonists; C437186:follicle stimulating hormone, human, with HCG C-terminal peptide; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone