A Patient Friendly Corifollitropin Alfa Protocol without Routine Pituitary Suppression in Normal Responders

Abstract

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.

An extremely patient-friendly and efficient stimulation protocol for assisted reproductive technology in normal and high responders

“…Moreover, daily injection of gonadotropins are needed in the aforementioned down-regulation protocols. Wang et al [ 35 ] proposed a patient-friendly corifollitropin alfa protocol using GnRH antagonist occasionally only when serum LH was ≧ 6 IU/L to reduce injections as much as possible. However, this method needs frequent blood withdrawals to monitor hormone levels for timely initiation of antagonist injection once LH rose above 6 IU/L, which is inconvenient and stressful on the other hand.…”

Concordance between different trophectoderm biopsy sites and the inner cell mass of chromosomal composition measured with a next-generation sequencing platform

“…All patients were from the outpatient department of a private fertility center (Hsinchu, Taiwan). The patients underwent individualized stimulation protocols for IVF/ICSI ( Wang et al , 2016 ; Hwang et al , 2018 ). The blastocysts used in the study were surplus embryos from patients who achieved successful live births.…”

Flexible Low-Dose GnRH Antagonist Protocol Is Effective in Patients With Sufficient Ovarian Reserve in IVF

“…Regardless, few studies have reported that reducing the GnRH-ant dose to as little as 0.125–0.2 mg per day is also equally effective (12–14). Wang et al even reported that routine GnRH-ant administration was not required, as 87.2% of the patients did not need any antagonist throughout the stimulation cycle (15). Thus, the minimum possible dose of GnRH antagonist that is suitable for IVF-ET remains controversial.…”