Corifollitropin alfa for poor responders patients, a prospective randomized study.

BACKGROUND: Poor ovarian response remains one of the biggest challenges for reproductive endocrinologists. The introduction of corifollitropin alpha (CFA) offered an alternative option to other gonadotropins for its longer half-life, its more rapid achievement of the threshold and higher FSH levels. We compared two different protocols with CFA, a long agonist and a short antagonist, and a no-CFA protocol. METHODS: Patients enrolled fulfilled at least two of the followings: AFC < 5, AMH < 1,1 ng/ml, less than three oocytes in a previous cycle, age > 40 years. Ovarian stimulation with an antagonist protocol was performed either with 300 UI rFSH and 150 UI rLH or 300UI HMG. In the long agonist group, after pituitary suppression with triptorelin, CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. In the short antagonist group CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. The primary objective was the effect on the number of oocytes and MII oocytes. Secondary objective were pregnancy rates, ongoing pregnancies and ongoing pregnancies per intention to treat. RESULTS: The use of CFA resulted in a shorter lenght of stimulation and a lower number of suspended treatments. Both the CFA protocols were significantly different from the no-CFA group in the number of retrieved oocytes (p < 0,05), with a non-significant difference in favour of the long agonist protocol. Both CFA groups yielded higher pregnancy rates, especially the long protocol, due to the higher number of oocytes retrieved (p < 0,05), as implantation rates did not differ. The cumulative pregnancy rate was also different, due to the higher number of cryopreserved blastocysts (p < 0,02). CONCLUSIONS: The long agonist protocol with the addition of rFSH and rLH showed the best results in all the parameters. A short antagonist protocol with CFA was less effective, but not significantly, although provided better results compared to the no-CFA group. We suggest that a long agonist protocol with CFA and recombinant gonadotropins might be a valuable option for poor responders. TRIAL REGISTRATION: The study was approved by the local Ethics Committee (EudraCT2015-002817-31).

[Transcervical electric resection in submucous myomas]. / Elettroresezione transcervicale dei miomi sottomucosi.

Twenty-five patients underwent hysteroscopic resection of large symptomatic intrauterine fibroids. Patients were divided into one of three groups: those with pedunculated myomas (G0), those with intramural extension less than 50% (G1), and those with fibroids with intramural extension more than 50% (G2). In the first group (7 patients) the age ranged from 42-52 years (mean age 48 years), the operating time ranged from 15-60 min. (mean time 27 minutes), and the amount of fluid used for irrigation ranged from 1000-10000 ml (mean fluid 4400 ml). Four of the seven patients had concomitant endometrial polyps. Follow-up ranged from 3-32 months (mean 21 months), one patient was lost, and the success rate in 6 was 100%. In the second group (9 patients) the age ranged from 30-54 years (mean age 43.5 years), the operating time ranged from 35-90 minutes (mean time 62 minutes), and the amount of fluid used ranged from 2800-12500 ml (mean fluid 7150 ml). In one case endometrial ablation was associated. Two patients (45 and 54 years) had histopathological diagnosis of malignancy (endometrial stromal nodule and stromal myoma) and required hysterectomy. No residual stromal nodule was found in the uterus following hysteroscopy resection in one case. Follow-up ranged from 6-38 months (mean 20 months), two patients was lost and one had repeat hysteroscopic procedure. Four of the nine patients had a successful outcome.(ABSTRACT TRUNCATED AT 250 WORDS)