ABSTRACT
ANTECEDENTES: La hiperestimulación ovárica controlada (HEOC) es uno de los componentes fundamentales de los ciclos de fecundación in-vitro (FIV). HEOC se ha realizado con gonadotrofinas exógenas de uso diario, agregando un componente de estrés adicional al tratamiento. La aparición de una FSH recombinante de depósito (corifollitropin alfa) permite disminuir el estrés asociado. Los estudios publicados no han mostrados diferencias en el número de ovocitos recuperados ni en las tasas de embarazo clínico. Los estudios existentes han sido financiados en su mayoría por la industria farmacéutica. OBJETIVO: Presentar la experiencia de la Unidad de Medicina Reproductiva Monteblanco con el uso de corifollitropin alfa en ciclos de FIV autólogos en pacientes no seleccionadas. MÉTODO: Se analizaron el número de ovocitos recuperados y la proporción de ovocitos en metafase 2 en pacientes sometidas a HEOC con corifollitropin alfa, FSH recombinante diaria (rFSH), y la combinación de FSH recombinante y urinaria. RESULTADOS: Se analizaron 727 ciclos de FIV: 270 con corifollitropin alfa, 33 con rFSH y 333 con combinación de FSH. No hubo diferencias significativas en la recuperación de ovocitos ni en la proporción de ovocitos en metafase 2. Al corregir por edad de la mujer y tipo de esquema de HEOC, encontramos que la edad de la mujer se asoció negativamente con el número de ovocitos recuperados, no así el tipo de esquema de HEOC. CONCLUSION: El uso de corifollitropin alfa en ciclos de FIV autólogos, no se diferencia significativamente de los otros esquemas de HEOC en la media de ovocitos recuperados ni en la media de ovocitos en metafase 2 obtenidos.
BACKGROUND: Controlled ovarian hyperstimulation (COH) is a main component of in-vitro fertilization (IVF) cycles. COH have been performed with daily exogenous gonadotropins administered, adding to treatment an additional component of stress. The appearance of a depot recombinant FSH (corifollitropin alfa) helps to reduce stress in patients undergoing IVF. No studies have shown differences in the number of retrieved oocytes or clinical pregnancy rates; however these studies have been funded by the pharmaceutical industry. AIMS: To show the experience of Reproductive Medicine Unit Monteblanco with the use of corifollitropin alpha in autologous IVF cycles, in unselected patients. METHODS: Our main outcome was the mean number of oocytes retrieved, and the proportion of oocytes in metaphase 2 in patients undergoing COH with corifollitropin alpha, daily recombinant FSH (rFSH), and a combination of rFSH and urinary gonadotropin. RESULTS: We analyzed 727 IVF cycles: 270 cycles with corifollitropin alpha, 33 exclusive rFSH and 333 cycles with rFSH combination and urinary gonadotropins. We did not found any statistically significant difference in the mean number of oocytes recovered nor the proportion of metaphase two oocytes obtained. After adjusting for age, we did not find that the COH protocol influenced the mean number of oocytes recovered. CONCLUSION: We concluded that the use of corifollitropin alpha in autologous IVF cycles does not alter the mean number of oocytes recovered, nor the proportion of oocytes in metaphase 2.
Subject(s)
Humans , Female , Ovulation Induction/methods , Fertilization in Vitro/methods , Follicle Stimulating Hormone, Human/administration & dosage , Follicle Stimulating Hormone, Human/pharmacology , Oocyte Retrieval/methods , Infertility , Linear Models , Reproductive MedicineABSTRACT
A prospective randomized, double blind, single centre study was conducted to compare the efficacy, efficiency and clinical side effects of daily fixed dose regimen of either 100 IU or 200 IU of recombinant follicle stimulating hormone(rFSH) Follitropin beta in down-regulated women undergoing controlled ovarian hyperstimulation(COH) for either conventional in vitro fertilization(IVF) or intracytoplasmic sperm injection(ICSI). A total of sixty women were randomly allocated according to the criteria for the treatment by either 100 IU(n = 30) or 200 IU (n = 30) of FSH. Although more cycle cancellations due to low response were observed in the 100 IU group (n = 9 vs n = 2), two cases of mild and moderate ovarian hyperstimulation syndrome were noted in the higher dose group. Subjects in the group treated with 200 IU appeared to yield more follicles > 17 mm (4.4 vs 3.3, p = 0.05) and more oocytes compared to the group treated with 100 IU (9.2 versus 6.0 oocytes, NS). The total dosage required to develop at least three follicles according to the protocol was significantly lower in the group treated with 100 IU (1203.33 versus 2106. 67, P < 0.0001). In conclusion, a fixed daily dose of 200 IU of rFSH Follitropin beta compared to a fixed daily dose of 100 IU is more effective in terms of follicles > 17 mm development and the number of oocytes retrieved along with a lower cancellation rate, but less efficient as indicated by a higher total rFSH dose needed