Limits...
Corifollitropin alfa compared to daily FSH in controlled ovarian stimulation for in vitro fertilization: a meta-analysis.

Fensore S, Di Marzio M, Tiboni GM - J Ovarian Res (2015)

Bottom Line: Women receiving corifollitropin alfa had a significantly higher number of metaphase II oocytes at ovum pick-up, and number of formed embryos, in comparison to rFSH.The risk of cycle cancellation due to overstimulation was significantly higher in the corifollitropin alfa group.Nevertheless, in view of the fact that corifollitropin alfa resulted in a higher number of metaphase II oocytes collected and a higher number of cycles cancelled due to overstimulation, corifollitropin alfa should be cautiously considered in women with the potential of being hyper responders.

View Article: PubMed Central - PubMed

Affiliation: Unità di Statistica, Dipartimento di Scienze Filosofiche, Pedagogiche ed Economico-Quantitative, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy. stefania.fensore@unich.it.

ABSTRACT
The present study offers a meta-analysis of published randomized controlled trials (RCTs) evaluating the outcomes of in vitro fertilization (IVF) cycles using corifollitropin alfa for controlled ovarian stimulation (COS) in comparison with daily recombinant FSH (rFSH). The study examined seven RCTs including 2138 patients receiving corifollitropin alfa and 1788 women receiving daily rFSH for COS. As a novel aspect, this meta-analysis included two specific subpopulations of IVF patients, i.e. egg donors and poor responders. There were no significant differences between corifollitropin alfa and rFSH with respect to the majority of the clinical parameters considered, and comparable were the outcomes in terms of live birth rate, ongoing pregnancy rate, and clinical pregnancy rate. Women receiving corifollitropin alfa had a significantly higher number of metaphase II oocytes at ovum pick-up, and number of formed embryos, in comparison to rFSH. The risk of cycle cancellation due to overstimulation was significantly higher in the corifollitropin alfa group. Ovarian hyperstimulation syndrome (OHSS) incidence was statistically comparable between patients receiving long lasting or daily rFSH. Nevertheless, in view of the fact that corifollitropin alfa resulted in a higher number of metaphase II oocytes collected and a higher number of cycles cancelled due to overstimulation, corifollitropin alfa should be cautiously considered in women with the potential of being hyper responders.

No MeSH data available.


Related in: MedlinePlus

Forest plot of comparison: Corifollitropin alfa versus daily recombinant FSH. a Live birth rate. b Ongoing pregnancy rate. c Clinical pregnancy rate per woman randomized. d Early miscarriage per woman randomized. e Duration of stimulation. f No. oocytes retrieved. g No. MII oocytes. h No. of embryos obtained per woman randomized. i OHSS incidence per woman randomized. j Cancellation due to overstimulation. k Cancellation due to understimulation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4465305&req=5

Fig2: Forest plot of comparison: Corifollitropin alfa versus daily recombinant FSH. a Live birth rate. b Ongoing pregnancy rate. c Clinical pregnancy rate per woman randomized. d Early miscarriage per woman randomized. e Duration of stimulation. f No. oocytes retrieved. g No. MII oocytes. h No. of embryos obtained per woman randomized. i OHSS incidence per woman randomized. j Cancellation due to overstimulation. k Cancellation due to understimulation

Mentions: The search yielded 51 studies of which 44 were excluded by screening through titles and abstracts (Fig. 1). Full manuscripts were retrieved for the remaining papers that included 6 full texts published in peer reviewed journals, and 1 abstract from the annual meeting of the American Society of Reproductive Medicine. Study characteristics are shown in Table 1. The seven trials enrolled a total of 3926 patients. The sample size ranged from 79 to 1506 women. In total, 2138 women were randomized to receive corifollitropin alfa and 1788 were randomized to receive daily rFSH. Results offered by the meta-analysis are shown in Fig. 2, A-K. There were differences in patient characteristics and selection. In the Engage study [12, 13] women aged 18–36 years, had a body mass index (BMI) of 18–32 kg/m2 and weighed 61–90 kg. In the Ensure trial [14], participants aged 18–36 years with a body weight ≤ 60 kg. In both Engage and Ensure trials patients with a history of ovarian hyper response to ovarian stimulation (more than 30 follicles ≥ 11 m) or OHSS, polycystic ovarian syndrome (PCOS) or more than 20 basal antral follicles on ultrasound (<11 mm, both ovaries combined) were excluded from the study. Women with a history of poor ovarian response were also excluded in both studies. In the Corifollitropin Alfa Dose-finding Study Group [9], patients were women aged 20–39 years with a BMI of 17–31 kg/m2 . In the Devroey et al. study [15], participants were between 18 and 39 year of age and a BMI 18–29 kg/m2). Patients with a history of OHSS, PCOS or poor response, were excluded. In the Requena et al. study [3], the oocyte donors included in the study aged 18–35 years, had regular menses and had a body weight > 60 kg with a BMI up to 29 kg/m2 with at least seven antral follicles at the beginning of the cycle. Donors having PCOS or multifollicular ovaries were excluded. The study of Kolibianakis et al. [16] included patients with previous poor ovarian response defined as retrieval of ≤4 COCs in a previous IVF cycle in which a starting dose of at least 450 IU per day was used, age <45 years, regular spontaneous menstrual cycle (24–35 days), body mass index (BMI) of 18–32 kg/m2 and basal FSH ≤20 IU/l. Differences among studies may represent sources of biases and, as it will be discussed later, influenced the result in terms of heterogeneity.Fig. 1


Corifollitropin alfa compared to daily FSH in controlled ovarian stimulation for in vitro fertilization: a meta-analysis.

Fensore S, Di Marzio M, Tiboni GM - J Ovarian Res (2015)

Forest plot of comparison: Corifollitropin alfa versus daily recombinant FSH. a Live birth rate. b Ongoing pregnancy rate. c Clinical pregnancy rate per woman randomized. d Early miscarriage per woman randomized. e Duration of stimulation. f No. oocytes retrieved. g No. MII oocytes. h No. of embryos obtained per woman randomized. i OHSS incidence per woman randomized. j Cancellation due to overstimulation. k Cancellation due to understimulation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4465305&req=5

Fig2: Forest plot of comparison: Corifollitropin alfa versus daily recombinant FSH. a Live birth rate. b Ongoing pregnancy rate. c Clinical pregnancy rate per woman randomized. d Early miscarriage per woman randomized. e Duration of stimulation. f No. oocytes retrieved. g No. MII oocytes. h No. of embryos obtained per woman randomized. i OHSS incidence per woman randomized. j Cancellation due to overstimulation. k Cancellation due to understimulation
Mentions: The search yielded 51 studies of which 44 were excluded by screening through titles and abstracts (Fig. 1). Full manuscripts were retrieved for the remaining papers that included 6 full texts published in peer reviewed journals, and 1 abstract from the annual meeting of the American Society of Reproductive Medicine. Study characteristics are shown in Table 1. The seven trials enrolled a total of 3926 patients. The sample size ranged from 79 to 1506 women. In total, 2138 women were randomized to receive corifollitropin alfa and 1788 were randomized to receive daily rFSH. Results offered by the meta-analysis are shown in Fig. 2, A-K. There were differences in patient characteristics and selection. In the Engage study [12, 13] women aged 18–36 years, had a body mass index (BMI) of 18–32 kg/m2 and weighed 61–90 kg. In the Ensure trial [14], participants aged 18–36 years with a body weight ≤ 60 kg. In both Engage and Ensure trials patients with a history of ovarian hyper response to ovarian stimulation (more than 30 follicles ≥ 11 m) or OHSS, polycystic ovarian syndrome (PCOS) or more than 20 basal antral follicles on ultrasound (<11 mm, both ovaries combined) were excluded from the study. Women with a history of poor ovarian response were also excluded in both studies. In the Corifollitropin Alfa Dose-finding Study Group [9], patients were women aged 20–39 years with a BMI of 17–31 kg/m2 . In the Devroey et al. study [15], participants were between 18 and 39 year of age and a BMI 18–29 kg/m2). Patients with a history of OHSS, PCOS or poor response, were excluded. In the Requena et al. study [3], the oocyte donors included in the study aged 18–35 years, had regular menses and had a body weight > 60 kg with a BMI up to 29 kg/m2 with at least seven antral follicles at the beginning of the cycle. Donors having PCOS or multifollicular ovaries were excluded. The study of Kolibianakis et al. [16] included patients with previous poor ovarian response defined as retrieval of ≤4 COCs in a previous IVF cycle in which a starting dose of at least 450 IU per day was used, age <45 years, regular spontaneous menstrual cycle (24–35 days), body mass index (BMI) of 18–32 kg/m2 and basal FSH ≤20 IU/l. Differences among studies may represent sources of biases and, as it will be discussed later, influenced the result in terms of heterogeneity.Fig. 1

Bottom Line: Women receiving corifollitropin alfa had a significantly higher number of metaphase II oocytes at ovum pick-up, and number of formed embryos, in comparison to rFSH.The risk of cycle cancellation due to overstimulation was significantly higher in the corifollitropin alfa group.Nevertheless, in view of the fact that corifollitropin alfa resulted in a higher number of metaphase II oocytes collected and a higher number of cycles cancelled due to overstimulation, corifollitropin alfa should be cautiously considered in women with the potential of being hyper responders.

View Article: PubMed Central - PubMed

Affiliation: Unità di Statistica, Dipartimento di Scienze Filosofiche, Pedagogiche ed Economico-Quantitative, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy. stefania.fensore@unich.it.

ABSTRACT
The present study offers a meta-analysis of published randomized controlled trials (RCTs) evaluating the outcomes of in vitro fertilization (IVF) cycles using corifollitropin alfa for controlled ovarian stimulation (COS) in comparison with daily recombinant FSH (rFSH). The study examined seven RCTs including 2138 patients receiving corifollitropin alfa and 1788 women receiving daily rFSH for COS. As a novel aspect, this meta-analysis included two specific subpopulations of IVF patients, i.e. egg donors and poor responders. There were no significant differences between corifollitropin alfa and rFSH with respect to the majority of the clinical parameters considered, and comparable were the outcomes in terms of live birth rate, ongoing pregnancy rate, and clinical pregnancy rate. Women receiving corifollitropin alfa had a significantly higher number of metaphase II oocytes at ovum pick-up, and number of formed embryos, in comparison to rFSH. The risk of cycle cancellation due to overstimulation was significantly higher in the corifollitropin alfa group. Ovarian hyperstimulation syndrome (OHSS) incidence was statistically comparable between patients receiving long lasting or daily rFSH. Nevertheless, in view of the fact that corifollitropin alfa resulted in a higher number of metaphase II oocytes collected and a higher number of cycles cancelled due to overstimulation, corifollitropin alfa should be cautiously considered in women with the potential of being hyper responders.

No MeSH data available.


Related in: MedlinePlus