Effectiveness of corifollitropin alfa used for ovarian stimulation of poor responder patients

Selman, Helmy; Rinaldi, Leonardo

doi:10.2147/ijwh.s117577

Cited by 9 publications

(2 citation statements)

References 46 publications

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“…However, its role in hyper-or poor responders women should be elucidated in further research [11]. Recently, corifollitropin alfa was offered to poor responder patients with promising, comparable results [12][13][14][15]. Of notice, in these studies, poor re-…”

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Should corifollitropin alfa be offered to patients with “genuine” poor response to controlled ovarian hyperstimulation?

Vanni¹,

Zilberberg²,

Manela³

et al. 2018

Clin. Exp. Obstet. Gynecol.

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Controlled ovarian hyperstimulation (COH) is considered a key factor in the success of in vitro fertilization-embryo transfer (IVF-ET), enabling the recruitment of multiple oocytes and, thereby, multiple, instead of single-ET [1]. However, owing to the extreme variability in ovarian response to COH, in a subgroup of patients, who are collectively referred to as "poor-responders" or "low responders", this method may yield a very small number of follicles, if any [2]. Moreover, until 2011, there was no one single acceptable definition, though the most widely used indicator was a decreased/poor response to COH, which in IVF cycles may be related to the number of oocytes retrieved. The recognition of the controversies surrounding the diagnostic criteria of patients with poor ovarian response (POR) has led to the ESHRE consensus on the definition of 'poor response' to ovarian stimulation for IVF (the Bologna criteria). According to the Bologna criteria, the minimal criteria needed to define POR are the presence of at least two of the following three features (1) Advanced maternal age (≥ 40 years) or any other risk factor for POR, (2) A previous POR (≤ 3 oocytes with a conventional stimulation protocol), and (3) an abnormal ovarian reserve test [3] Many strategies are offered for the treatment of patients with poor ovarian response (POR) to COH, including the use of gonadotropin-releasing hormone-antagonist (GnRHant), reducing or stopping the dose of GnRH-agonist (GnRH-ag), the ultrashort, short and microdose GnRH-ag "flare" protocols), the combined ultrashort GnRH-ag with the multiple GnRH-ant, the administration of letrozole, the modified natural-IVF cycle [2,[4][5][6][7]8] or the use of different type and doses of gonadotropin preparations [9-10]. Nevertheless, no compelling advantage for one stimulation protocol over another has been hitherto established.Corifollitropin alfa or FSH-CTP, is a long-acting FSH that following a single-dose is able to initiate and maintain follicular growth during the first seven days of COH [11]. It was found to be equally effective compared to daily FSH in women with unexplained subfertility. However, its role in hyper-or poor responders women should be elucidated in further research [11]. Recently, corifollitropin alfa was offered to poor responder patients with promising, comparable results [12][13][14][15]. Of notice, in these studies, poor re-

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“…sponder patients were defined according to the Bologna [12,13,15], or a modification of Bologna criterias [14], and the control group received different doses of daily gonadotropins, ranging from 225 IU [15] to 450 [14].…”

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confidence: 99%