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Journal of Assisted Reproduction and Genetics

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01-05-2020 | Ovarian Hyperstimulation Syndrome | Assisted Reproduction Technologies

A prospective randomized trial comparing corifollitropin-α late-start (day 4) versus standard administration (day 2) in expected poor, normal, and high responders undergoing controlled ovarian stimulation for IVF

Authors: Alberto Revelli, Gianluca Gennarelli, Marta Sestero, Stefano Canosa, Andrea Carosso, Francesca Salvagno, Giulia Pittatore, Claudia Filippini, Chiara Benedetto

Published in: Journal of Assisted Reproduction and Genetics | Issue 5/2020

Abstract

Objective

To assess whether corifollitropin-α (CFα) late-start administration (day 4) and standard administration (day 2) can obtain similar oocyte yield and live birth rate.

Study design

A randomized controlled trial.

Setting

University Hospital IVF Unit.

Patients

One hundred thirteen women undergoing IVF.

Interventions

Patients distributed in three subgroups (expected poor, normal, or high responders to FSH) were randomized into two treatment arms: (a) CFα late-start: CFα on day 4 + GnRH antagonist from day 8 + (when needed) recFSH from day 11; (b) CFα standard start: CFα on day 2 + GnRH antagonist from day 6 + (when needed) recFSH from day 9. IVF or ICSI was performed as indicated.

Results

Considering the whole study group, the late-start regimen obtained comparable oocyte yield (8.9 ± 5.6 vs. 8.8 ± 6.2; p = n.s.), cPR/started cycle (25% vs. 31.6%, p = n.s.), and cumulative live birth rate (LBR)/ovum pickup (OPU) (29.2% vs. 37.7%, p = n.s.) than the standard regimen. The outcome of the two regimens was comparable in the two subgroups of high and normal responders. Differently, in poor responders, oocyte yield was similar, but LBR/OPU was significantly lower with late-start CFα administration that caused 40% cancellation rate due to monofollicular response. ROC curves showed that the threshold AMH levels associated with cycle cancellation were 0.6 ng/ml for late-start regimen and 0.2 ng/ml for standard regimen.

Conclusion

CFα may be administered on either day 2 or day 4 to patients with expected high or normal response to FSH without compromising oocyte yield and/or live birth rate. Differently, late-start administration is not advisable for expected poor responders with AMH ≤ 0.6 ng/ml.

Trial registration

NCT03816670

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Title: A prospective randomized trial comparing corifollitropin-α late-start (day 4) versus standard administration (day 2) in expected poor, normal, and high responders undergoing controlled ovarian stimulation for IVF
Authors: Alberto Revelli
Gianluca Gennarelli
Marta Sestero
Stefano Canosa
Andrea Carosso
Francesca Salvagno
Giulia Pittatore
Claudia Filippini
Chiara Benedetto
Publication date: 01-05-2020
Publisher: Springer US
Keyword: Ovarian Hyperstimulation Syndrome
Published in: Journal of Assisted Reproduction and Genetics / Issue 5/2020
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-020-01742-5

At a glance: The STEP trials

Springer Medicine

A prospective randomized trial comparing corifollitropin-α late-start (day 4) versus standard administration (day 2) in expected poor, normal, and high responders undergoing controlled ovarian stimulation for IVF

Abstract

Objective

Study design

Setting

Patients

Interventions

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Study design

Setting

Patients

Interventions

Results

Conclusion

Trial registration

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