Abstract
BackgroundPoor ovarian response remains one of the biggest challenges for reproductive endocrinologists. The introduction of corifollitropin alpha (CFA) offered an alternative option to other gonadotropins for its longer half-life, its more rapid achievement of the threshold and higher FSH levels. We compared two different protocols with CFA, a long agonist and a short antagonist, and a no-CFA protocol.MethodsPatients enrolled fulfilled at least two of the followings: AFC < 5, AMH < 1,1 ng/ml, less than three oocytes in a previous cycle, age > 40 years. Ovarian stimulation with an antagonist protocol was performed either with 300 UI rFSH and 150 UI rLH or 300UI HMG. In the long agonist group, after pituitary suppression with triptorelin, CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. In the short antagonist group CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. The primary objective was the effect on the number of oocytes and MII oocytes. Secondary objective were pregnancy rates, ongoing pregnancies and ongoing pregnancies per intention to treat.ResultsThe use of CFA resulted in a shorter lenght of stimulation and a lower number of suspended treatments. Both the CFA protocols were significantly different from the no-CFA group in the number of retrieved oocytes (p < 0,05), with a non-significant difference in favour of the long agonist protocol. Both CFA groups yielded higher pregnancy rates, especially the long protocol, due to the higher number of oocytes retrieved (p < 0,05), as implantation rates did not differ. The cumulative pregnancy rate was also different, due to the higher number of cryopreserved blastocysts (p < 0,02).ConclusionsThe long agonist protocol with the addition of rFSH and rLH showed the best results in all the parameters. A short antagonist protocol with CFA was less effective, but not significantly, although provided better results compared to the no-CFA group. We suggest that a long agonist protocol with CFA and recombinant gonadotropins might be a valuable option for poor responders.Trial registrationThe study was approved by the local Ethics Committee (EudraCT2015–002817-31).
Highlights
Poor ovarian response remains one of the biggest challenges for reproductive endocrinologists
A comparison was done between the use of corifollitropin plus recombinant follicle stimulating hormone (rFSH)/recombinant luteinizing hormone (rLH) both using a long agonist or an antagonist protocol, and the use of an antagonist protocol without corifollitropin alpha (CFA) with a maximal dose of human menopausal gonadotropin (HMG) or rFSH/ rLH (300 UI of FSH activity and 150UI of LH)
The use of CFA resulted in a shorter length of stimulation in both CFA groups compared to the control (p < 0,05), with a not significant difference between the two CFA groups, the antagonist CFA was the group with less days of treatment and less controls (Table 1)
Summary
Poor ovarian response remains one of the biggest challenges for reproductive endocrinologists. Poor ovarian response remains one of the biggest causes of poor outcome in women undergoing ovarian stimulation, with a prevalence ranging from 9 to 24% [1]. The definition of poor responder has been a confounding matter, in that different criteria were used by reserchers. All the studies showed how pregnancy rates in poor ovarian responders remained substantially low [5]. In 2001 the definition of poor responders has been uniformed with the introduction of Bologna criteria [6], but still all the studies in patients fulfilling the Bologna criteria resulted in very low pregnancy rates, irrespective of patients’ age and type of ovarian stimulation protocol [4, 7]
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