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.

  • Micah Hill

    Thank you Dr Polyzos for the very nice article. The early rise in serum FSH from corifollitropin in poor responders unfortunately did not translate into better ART outcomes. It is nice to see articles using the Bologna criteria and this article clearly demonstrated the poor reproductive potential in patients meeting this criteria. Unfortunately practical methods to improve outcomes in these patients remain elusive.

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