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A patient friendly corifollitropin alfa protocol without routine pituitary suppression in normal responders



Author
Huai-Ling Wang1, Hsing-Hua Lai1, Tzu-Hsuan Chuang1, Yu-Wei Shih1, Shih-Chieh Huang1, Meng-Ju Lee1, Shee-Uan Chen2
Affiliation
1Stork Fertility Center, Stork Ladies Clinic, HsinchuTaiwan (R.O.C)
2Department of Obstetrics and Gynecology, National Taiwan University Hospital and College of Medicine, TaipeiTaiwan (R.O.C)
Publication
Keywords
Corifollitropin alfa;  Controlled ovarian stimulation;  GnRH antagonist












Introduction

Reducing the frequency of injections in an in vitro fertilization (IVF) program is a patient-friendly way to decrease the mental stress and financial burden in infertile couples. 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, and it may further simplify the injection protocol.


Materials and Methods

Study Design, Size, Duration: A retrospective cohort study was conducted at a private fertility center in Taiwan. Between January 2013 and September 2014, a total of 288 patients were included in the study.
Participants/Materials, Setting, Methods: 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 (0.25mg) was only used prophylactically when the luteinizing hormone (LH) was ≧ 6 IU/L (over half of the definitive LH surge). The demographic profile was shown as below:

Results

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. The stimulation profile was shown as below:
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 ongoing pregnancy rate after first cryotransfer is 56.3%, while the final cumulative live birth rate is 69.6%.

Of patients who did and did not receive GnRH antagonist during stimulation, no significant difference existed in their demographics and reproductive outcomes (cumulative live birth rate: 78.4% vs. 68.3%, p=0.35). The comparisons between the patient received GnRH antagonist and those did not during the stimulation were shown as below:

Discussions and Conclusions

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.
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