Female Infertility, Poor Responder
Conditions
Keywords
Poor responders, IVF, GnRH agonist, GnRH antagonist, recombinant FSH
Brief summary
Despite the progression in assisted reproductive technology (ART), poor ovarian response to controlled ovarian stimulation remains a challenge for clinicians and a source of distress for patients. Multiple strategies have been tried to overcome these obstacles. The increase of the gonadotropin administration have been associated with a very low pregnancy rate. The introduction of GnRH agonist protocol, which takes advantage of the initial rise in endogenous gonadotropins that follows the agonist administration in the early follicular phase and subsequently prevents a premature LH surge, with fewer cycle cancellations, have improved cycle parameters and increased pregnancy rate. Recently, GnRH antagonists were introduced in ART treatment. They are effective in preventing a premature LH surge and allow for a more natural recruitment of follicles in the follicular phase in a non suppressed ovary. However, the randomized studies comparing the efficacy of these two regimens reported conflicting and nonsignificant results. Moreover, more recently adjuvant therapies for COH such as growth hormone therapy or pyridostigmine, oral L-arginine, and transdermal testosterone failed to improve IVF outcomes. Recently, the new treatment option with corifollitropin alfa, able to keep the circulating FSH level above the threshold necessary to support multi-follicular growth for an entire week, in a GnRH antagonist protocol seems to have a potential beneficial effect in poor responders. The aim of this study is to compare long-acting FSH/GnRH antagonist with daily FSH/GnRH antagonist with short GnRH agonist protocol on IVF outcome in poor responder patients .
Interventions
DRUGLong acting FSH and GnRH antagonist
Woman in long acting FSH and GnRH antagonist arm receive an initial dose of 150 mcg Corifollitropin alfa on second day of the menstrual cycle followed by a fixed daily dose of 0.25 mg of GnRH antagonist on day 7 of the cycle onwards. On the ninth day of the cycle, a daily fixed dose of 300 IU of recombinant FSH will be administered until the day of ovulation triggering.
DRUGDaily FSH and GnRH antagonist
Woman in daily FSH and GnRH antagonist arm receive a fixed dose of 300 IU of recombinantFSH starting 3 day of the menstrual cycle followed by a fixed daily dose of 0.25 mg of GnRH antagonist on day 7 of the cycle onwards until the day of ovulation triggering.
DRUGTriptorelin and recombinant FSH
Women in Triptorelin and recombinant FSH arm receive a fixed dose of 0.05 mg of Triprorelin from the 1 day of the menstrual cycle followed by a fixed dose of 300 IU of recombinant FSH starting 3 day untill the day of HCG administration.
Sponsors
Bioroma
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
25 Years to 44 Years
Healthy volunteers
No
Inclusion criteria
* women with at least two of the following criteria: I) age \> 40 years old; II) basal follicular stimulation hormone (FSH) \> 12 mIU/ml; III) three or fewer oocytes retrieved in the previous IVF cycle; IV) low estradiol levels on the day of human chorionic gonadotropin (hCG) administration (\< 1500 pmol/ml).
Exclusion criteria
* body mass index \> 30 * biochemical and ultrasound evidence of polycystic ovary syndrome * stage III-IV endometriosis * inflammatory or autoimmune disorders * metabolic disease * infertility medications (gonadotropins, clomiphene citrate) within the past two months
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Clinical pregnancy rate | Time Frame: until 12th gestational week |
Secondary
| Measure | Time frame |
|---|---|
| Implantation rate | Time Frame: until 12th gestational week |
Countries
Italy
Contacts
Primary ContactMauro Schimberni, MD
Outcome results
None listed