Corifollitropin alpha followed by rFSH in a GnRH antagonist protocol for poor ovarian responder patients An observational pilot study

Capsule:
Although pregnancy rates in “Bologna-criteria poor ovarian responders” treated with corifollitropin alpha in a GnRH antagonist protocol are low, this should be interpreted with caution given the very poor prognosis of this population.

Authors:
Nikolaos P. Polyzos, M.D., Ph.D., Michel DeVos, M.D., Ph.D., Peter Humaidan, M.D., Ph.D., Dominic Stoop, M.D., Carolina Ortega-Hrepich, M.D., Paul Devroey, M.D., Ph.D., Herman Tournaye, M.D., Ph.D.

Volume 99, Issue 2, Pages 422-426, February 2013

Abstract:

Objective:
To identify whether women with poor ovarian response may benefit from treatment with corifollitropin alfa in a GnRH antagonist protocol.

Design:
Retrospective pilot study.

Setting:
University-based tertiary care center.

Patients:
Poor ovarian responders fulfilling the Bologna criteria developed by European Society for Human Reproduction and Embryology Consensus Group.

Interventions:
Corifollitropin alpha (150μg) followed by 300 IU of rFSH in a GnRH antagonist protocol.

Main Outcome Measures:
Endocrinological profile and ongoing pregnancy rates.

Results:
Among 43 women treated with corifollitropin alfa, mean E2 levels showed an increasing pattern during the follicular phase, reaching 825 ng/L on the day of hCG administration, whereas FSH values showed a marked increase during the first 5 days, reaching a mean value of 35 IU/L and remaining above 20 IU/L during the late follicular phase. Cycle cancellation rate was 32.6% and embryo transfer rate 53.3%. Five patients (11.7%) had a positive hCG test and three (7%) had an ongoing pregnancy. Ongoing pregnancy rates were 11.1% per oocyte retrieval and 13% per embryo transfer. Ongoing pregnancy rates per patient did not significantly differ compared with a cohort of patients treated during 2011 with the standard protocol for poor responders in our center (short agonist-hMG) (7% vs. 6.3%).

Conclusion:
Treatment of poor ovarian responders, as described by the Bologna criteria, with corifollitropin alfa in a GnRH antagonist protocol results in low pregnancy rates, similarly to conventional stimulation with a short agonist protocol.

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