Revelli Alberto, Pittatore Giulia, Casano Simona, Canosa Stefano, Evangelista Francesca, Benedetto Chiara
Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, Department of Surgical Sciences, University of Torino, Torino, Italy,
J Assist Reprod Genet. 2015 Mar;32(3):429-34. doi: 10.1007/s10815-014-0426-6. Epub 2015 Jan 15.
To investigate efficacy and safety of a controlled ovarian stimulation (COS) protocol in which a single dose of Corifollitropin-alfa (CFα) was administered on day 4 of a GnRH-antagonist cycle.
Cohort case-control study.
University Hospital.
One hundred twenty-two normally cycling women expected to be normal responders to COS.
In 61 patients, CFα (100-150 μg) was injected subcutaneously on day 4 of a spontaneous menstrual cycle; a GnRH-antagonist was added from day 8 (fixed protocol; 0.25 mg/day). If needed to complete follicular maturation, recombinant FSH (rFSH) daily injections (150/200 IU/day) were given from day 11. A control group of 61 matched women was stimulated with daily subcutaneous injections of rFSH (100-150 U/day) from day 4 of the cycle, and received GnRH-antagonist (0.25 mg/day) from day 8. IVF or ICSI was performed according to the sperm characteristics, and 1-2 embryos were transferred in utero under US guidance on day 2.
Number of retrieved cumulus-oocyte complexes (COCs), clinical pregnancy rate (PR), implantation rate (IR), ongoing PR at 10 weeks, number of injections/cycle, ovarian hyperstimulation syndrome (OHSS) rate.
No cycle was cancelled and the mean number of retrieved COCs was comparable in patients and controls. About 60% of CF-alfa treated women had no need of daily rFSH addition, and the mean number of injections/cycle was significantly lower in the CF-alfa group than in controls (p < 0.05). The ongoing PR/transfer was 36.8% in CF-alfa group and 37.5% in controls. No patient developed severe OHSS, and the incidence of moderate OHSS was similar in cases and controls.
CFα may be started on day 4 of the cycle obtaining results comparable to those of a COS using day 4-start daily rFSH, with significantly less injections and a similar risk of OHSS.
探讨在促性腺激素释放激素（GnRH）拮抗剂周期第4天给予单剂量注射用重组促卵泡素α（CFα）的控制性卵巢刺激（COS）方案的有效性和安全性。
队列病例对照研究。
大学医院。
122名月经周期正常且预计对COS反应正常的女性。
61例患者在自然月经周期第4天皮下注射CFα（100 - 150μg）；从第8天开始添加GnRH拮抗剂（固定方案；0.25mg/天）。若需要完成卵泡成熟，从第11天开始每日注射重组促卵泡素（rFSH）（150/200IU/天）。61例匹配的对照组女性从周期第4天开始每日皮下注射rFSH（100 - 150U/天），并从第8天开始接受GnRH拮抗剂（0.25mg/天）。根据精子特征进行体外受精（IVF）或卵胞浆内单精子注射（ICSI），并在第2天超声引导下向子宫内移植1 - 2个胚胎。
回收的卵丘 - 卵母细胞复合体（COC）数量、临床妊娠率（PR）、着床率（IR）、10周时的持续妊娠率、每个周期的注射次数、卵巢过度刺激综合征（OHSS）发生率。
无周期取消，患者和对照组回收的COC平均数量相当。约60%接受CFα治疗的女性无需额外每日注射rFSH，CFα组每个周期的平均注射次数显著低于对照组（p < 0.05）。CFα组的持续妊娠率/移植率为36.8%，对照组为37.5%。无患者发生严重OHSS，中度OHSS的发生率在病例组和对照组中相似。
在周期第4天开始使用CFα可获得与从第4天开始每日使用rFSH进行COS相当的结果，注射次数显著减少，且OHSS风险相似。
