Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Shih-Pai Road Section 2, Taipei, 112, Taiwan, Republic of China.
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Reprod Biol Endocrinol. 2018 Mar 5;16(1):18. doi: 10.1186/s12958-018-0335-0.
The use of oral progestin has been shown to effectively prevent luteining hormone (LH) surge during ovarian stimulation with daily human menopausal gonadotropin injections. This study was aimed to investigate the efficacy of long-acting follicle stimulating hormone (long-acting FSH; corifollitropin alfa, Elonva®) use in progestin-primed ovarian stimulation for normal and high responders undergoing IVF/ICSI.
This is a retrospective and proof-of-concept study. We developed an extremely patient-friendly protocol to be applied to forty-five normal or high responders, in which a single injection of corifollitropin alfa (Elonva®) was administered and medroxyprogesterone acetate (MPA) was taken orally every day from the day after Elonva injection to the day of trigger. Seven days after Elonva injection, folliculometry and hormone tests were performed, followed by short-acting daily FSH/LH injections, if needed, until the day before trigger. Duration of stimulation, number of injections and visits before trigger, incidence of premature LH surge, the number of oocytes retrieved, fertilization rate, cleavage rate, the rate of day 2 good embryos available, and cumulative ongoing pregnancy rate per retrieval were assessed.
The average age of the population was 34.7 years. Duration of stimulation was 9.4 days in average. Before trigger, only 3.6 injection shots and 1.4 visits were needed on average. There was no case of premature LH surge. Number of oocytes retrieved was 13.7, fertilization rate was 79.04%, cleavage rate was 91.11%, and day 2 good embryo rate was 64.34%, in average respectively. There was no case of ovarian hyperstimulation syndrome. The cumulative ongoing pregnancy rate per oocyte retrieval achieved a satisfactory level as 53.1%.
Our protocol consisting of long-acting FSH injection and oral MPA preventing LH surge reduces the number of injections and visits to an extreme and achieves a satisfactory reproductive outcome, and, therefore, is a really patient-friendly and effective approach to ovarian stimulation.
已证实，在人绝经期促性腺激素（hMG）每日注射进行卵巢刺激时，使用口服孕激素可有效预防黄体生成素（LH）峰。本研究旨在探讨长效卵泡刺激素（长效 FSH；corifollitropin alfa，Elonva®）在 IVF/ICSI 中用于孕激素预刺激的正常和高反应者卵巢刺激中的疗效。
这是一项回顾性和概念验证研究。我们开发了一种非常方便患者的方案，应用于 45 例正常或高反应者，其中从 Elonva 注射后的第二天开始每天口服醋酸甲羟孕酮（MPA），同时单次注射 corifollitropin alfa（Elonva®）。Elonva 注射后 7 天进行卵泡计数和激素检测，如果需要，直到扳机前一天每天注射短效 FSH/LH。评估刺激持续时间、扳机前的注射次数和就诊次数、过早 LH 峰的发生率、获卵数、受精率、卵裂率、第 2 天优质胚胎的可利用率以及每个取卵周期的累积持续妊娠率。
人群的平均年龄为 34.7 岁。平均刺激持续时间为 9.4 天。扳机前平均只需注射 3.6 次和就诊 1.4 次。没有过早 LH 峰的病例。平均获卵数为 13.7 枚，受精率为 79.04%，卵裂率为 91.11%，第 2 天优质胚胎率为 64.34%。没有卵巢过度刺激综合征的病例。每个取卵周期的累积持续妊娠率达到了 53.1%的满意水平。
我们的方案包括长效 FSH 注射和口服 MPA 预防 LH 峰，将注射次数和就诊次数减少到极致，并获得了满意的生殖结局，因此是一种真正方便患者且有效的卵巢刺激方法。
