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Optimizing endometrial receptivity for patients with recurrent implantation failure
Published in Efstratios M. Kolibianakis, Christos A. Venetis, Recurrent Implantation Failure, 2019
Christos A. Venetis, Julia K. Bosdou, Efstratios M. Kolibianakis
An alternative strategy that has also been proposed is reducing the steroidogenic drive on the granulosa cells of the developing follicles around the end of the follicular phase. Since progesterone elevation is considered to be mainly due to small amounts of progesterone produced by the granulosa cells of multiple follicles under the action of gonadotrophins,45 reducing the concentration of gonadotrophins might have a beneficial effect. This was indirectly shown in a recent RCT in which it was demonstrated that performing ovarian stimulation in poor responders for the first seven days with a single dose of 150 μg of corifollitropin alfa (CFA) led to significantly lower serum concentrations of progesterone on day eight of stimulation when compared with patients who were stimulated with a daily dose of 450 IU of follitropin beta despite the fact that the number of developing follicles was similar between the two groups.58 This could be attributed to the unique pharmacokinetic profile of a single CFA injection which is characterized by an initially high concentration of CFA followed by a gradual decrease, similarly to a step-down protocol. This finding was recently confirmed in a reanalysis of two large RCTs on the use of CFA (ENGAGE and PURSUE) which demonstrated that the incidence of progesterone elevation in patients who were triggered after a single dose of CFA (i.e., on day eight) was significantly lower compared with those who were stimulated with daily recombinant FSH and triggered also on day eight.59
Oocyte retrieval and selection
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Laura F. Rienzi, Filippo M. Ubaldi
Over the past few years, particular attention has been also paid to the development of simplified ovarian stimulation regimens in order to identify novel, more convenient approaches as valid alternatives to existing protocols. In this context, the quite recent introduction of a long-acting FSH, corifollitropin alfa, is notable. This new therapeutic option, consisting of a chimeric recombinant molecule composed of FSH and the carboxy-terminal peptide of hCG, functions as a long-acting FSH agonist. Corifollitropin alfa has a longer half-life compared to recombinant FSH (rFSH) and therefore a single injected dose is sufficient to effectively induce and sustain multifollicular growth (83–86). The effectiveness and safety of the treatment have been shown by the absence of any registered difference in clinical pregnancy rate, ongoing pregnancy rate, multiple pregnancy rate, miscarriage rate, ectopic pregnancy rate, and congenital malformation rate (major or minor) (86).
To Flush Follicles during Egg Collection or Not
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Treatment was as follows: (Previous cycle: Oral contraceptive) Cycle day 3: 150 Mikrogramm Elonva (Corifollitropin alfa)Day 9: 1. Egg Collection: Canceling egg collection after aspiration and flushing half of follicles at right ovary due to sporadic granulosa cells only and 3 retrieved immature oocytes (1 M I, 2× GV)Evening of day 9: Agonist triggering ovulation with 2 Amp. DECAPEPTYL 0.1 mg/1 mL (100 Mikrogramm Triptorelinacetat)Day 11: 2. Egg Collection: 36 hours after agonist trigger. Out of both ovaries 16 oocytes, 13 MII for intracytoplasmic sperm injection (ICSI).(Result of 1. Egg collection: 1× in vitro maturation (IVM) ICSI after 24 hours IVM: 1× 3PN Result of 2. Egg Collection: out of 13× ICSI on day of Egg Collection: 10× 2PN)Day 5: 5 BlastocystsDay 6: 2 more BlastocystsFreeze-all policy due to unsynchronized endometrium.
DuoStim cycles potentially boost reproductive outcomes in poor prognosis patients
Published in Gynecological Endocrinology, 2021
Gustavo N. Cecchino, Matheus Roque, María Cerrillo, Rodrigo da Rosa Filho, Flavia da Silva Chiamba, Juliana Halley Hatty, Juan A. García-Velasco
The main outcome was the number of retrieved oocytes per cycle. Secondary outcomes included the duration of the stimulation, the total dose of gonadotropins received, the number of mature (MII) oocytes, fertilization rate (ratio between fertilized eggs and mature oocytes), blastocyst formation rate (percentage of total blastocyst obtained per number of fertilized eggs), and the number of blastocysts per cycle. Corifollitropin alfa was considered equivalent to a daily dose of 200 IU of FSH during the first seven days, as suggested by the ENGAGE trial [14]. We did not assess the aneuploidy rates as well as live birth rates, because many patients decided not to perform preimplantation genetic testing for aneuploidies and due to our limited sample size. The study was not powered enough to detect differences in reproductive outcomes.
A pilot study comparing corifollitropin alfa associated with hp-HMG versus high dose rFSH antagonist protocols for ovarian stimulation in poor responders
Published in Human Fertility, 2020
Stéphanie Mendret-Pellerin, Florence Leperlier, Arnaud Reignier, Tiphaine Lefebvre, Paul Barrière, Thomas Fréour
A few years ago, corifollitropin alfa became available for ovarian stimulation. This recombinant hormone consists of an FSH alfa subunit, associated with FSH beta subunit fused with the C-terminal peptide of human chorionic gonadotropin (hCG) beta subunit. Corifollitropin alfa acts like a long-acting FSH, with a single dose keeping circulating FSH level above the threshold necessary to support multi-follicular growth for 7 days, thus replacing the first 7 daily injections of rFSH. The single-dose pharmacokinetic profile of corifollitropin alfa is characterized by highest FSH activity during the first 2 days of stimulation, followed by decreasing FSH activity. The FSH threshold level is reached faster with corifollitropin alfa (approximately 24 hours after injection) than with daily FSH injections where about 3 days of injections are necessary (Fauser et al., 2009).
Is corifollitropin alfa effective in controlled ovarian stimulation among all poor ovarian responders? A retrospective comparative study
Published in Gynecological Endocrinology, 2019
A. Andrisani, L. Marin, E. Ragazzi, G. Donà, L. Bordin, F. Dessole, D. Armanini, F. Esposito, A. Vitagliano, C. Sabbadin, G. Ambrosini
Corifollitropin alfa is a new molecule, analogous of FSH with a more sustained follicle stimulating activity in comparison to daily gonadotropins. Different studies have tested its effectiveness in POR with conflicting results, probably due to the heterogeneity of patients’ characteristics. Thus, in this study, we evaluated the effectiveness of corifollitropin alfa compared with daily rFSH/hMG in two subgroups of POR (according to ‘Bologna Criteria’) stratified according to AFC. We found that corifollitropin alfa was comparable to FSH/hMG in terms of total oocytes, MII oocytes, FORT, total embryos, IR, CPR, MR, and LBR in women with AFC > 5, in line with the previous data by Kolibianakis et al. [17]. This is a substantial finding of our study, as it adds evidence on the validity of corifollitropin alfa as an alternative to ‘traditional molecules’ for COS in POR with a non-critical reduction of antral follicles. Moreover, corifollitropin alfa may have an important advantage in comparison to daily drugs in this category of POR, namely a lower burden related to drug self-administration. It is common knowledge that POR often need to undergo repeated COS before achieving a clinical pregnancy, thus the practical benefit of a single drug-injection should be interpreted in a wider scenario of multiple repeated IVF attempts.