Cumulative Live Birth Rates Following Stimulation With Corifollitropin Alfa Compared With hp-hMG in a GnRH Antagonist Protocol in Poor Ovarian Responders.

Joaquín Errázuriz,Neelke De Munck,Herman Tournaye,Panagiotis Drakopoulos,Alessia Romito,Christophe Blockeel,Michel De Vos,Billie Frederix,Analissa Racca

doi:10.3389/fendo.2019.00175

Abstract

Background: Bologna criteria poor ovarian responders have a very low prognosis. Although, it has been proposed that LH supplementation could be beneficial in women with previous hypo-response to FSH. There are no studies comparing the cumulative live birth rates (LBRs) between corifollitropin alfa (CFA) and highly purified human menopausal gonadotrophin (hp-hMG).Objective: To compare cumulative LBRs in Bologna poor ovarian responders undergoing ovarian stimulation with CFA followed by hp-hMG vs. hp-hMG alone in a GnRH antagonist protocol.Design: This is a retrospective cohort study. We included in total 917 poor responders fulfilling the Bologna criteria for poor ovarian response (POR) at a university-affiliated tertiary center from January 2011 until March 2017. Patients were administered either fixed daily doses of 300–450 IU of hp-hMG (group A) or a single dose of 150 μg of CFA followed by daily injections of ≥300 IU of hp-hMG from Day 8 of stimulation until the day of ovulation trigger (group B), in a fixed GnRH antagonist protocol.Results: LBRs after fresh embryo transfer (ET) were similar in group A 71/510 (14%) and B 42/407 (10%). Cumulative LBR per cycle was significantly higher in group A (16.9%) compared to group B (11.8%); (P = 0.03). However, logistic regression analysis showed no association between the type of gonadotropin administered and cumulative LBR. Only age was significantly associated with cumulative LBR (OR = 0.93, P = 0.007).Conclusion: Cumulative LBRs are similar in Bologna poor responders stimulated with CFA followed by hp-hMG compared to hp-hMG monotreatment in an antagonist protocol.

Highlights

Poor ovarian response (POR) is observed in at least 10% of infertile women but the incidence rises with advancing age
To compare cumulative live birth rates (LBRs) in Bologna poor ovarian responders undergoing ovarian stimulation with Corifollitropin alfa (CFA) followed by highly purified human menopausal gonadotrophin (hp-hMG) vs. hp-hMG alone in a GnRH antagonist protocol
Cumulative LBRs are similar in Bologna poor responders stimulated with CFA followed by hp-hMG compared to hp-hMG monotreatment in an antagonist protocol

Summary

Introduction

Poor ovarian response (POR) is observed in at least 10% of infertile women but the incidence rises with advancing age. Corifollitropin alfa (CFA) is a long acting gonadotropin that has been designed as a sustained follicle stimulant with the ability to simplify ovarian stimulation, given that a single subcutaneous injection can replace the first seven injections of any folliclestimulating hormone (FSH) preparation [6]. This is important if we consider the psychological distress and the high dropout rates observed in IVF patients [7]. There are no studies comparing the cumulative live birth rates (LBRs) between corifollitropin alfa (CFA) and highly purified human menopausal gonadotrophin (hp-hMG)

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Conclusion