In-vitro fertilization experience with follitropin-delta in poor responders identified by POSEIDON Classification.

IF 1.6 Q3 OBSTETRICS & GYNECOLOGY
Peter Kovacs, David U Nagy, Szabolcs Matyas, Elizabeth Culberson, Chantal Kinsey, Yao Lu, Steven R Lindheim
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Abstract

Background: Controlled ovarian stimulation during in-vitro fertilization (IVF) is personalized based on anticipated hyper, normal, poor response. With respect to poor responders, who are often treated using higher gonadotropin dosing and combination of urinary and recombinant gonadotropins (rFSH) with marginal benefit, we report our experience with a newer, more potent rFSH (Follitropin-δ) undergoing IVF.

Methods: Retrospective analysis of all IVF cycles in which follitropin-δ was used alone or combined with urinary gonadotropins over a 3-year period. Patients were grouped according to the POSEIDON Classification as expected low responders (POSEIDON 3-4; AMH<1.2; N.=45), unexpected low responders (POSEIDON 1-2; retrieval of ≤9 oocytes; N.=67) and those with a normal response (N.=93). Demographic, stimulation (including target number of retrieved oocytes [8 to14]), embryology and clinical outcome parameters (clinical pregnancy rate [CPR], live birth rate [LBR], cumulative live birth rate [cLBR]) were compared.

Results: Those categorized as POSEIDON patients were older, had lower ovarian reserve, were more likely to use a mixed protocol, less likely to reach the target oocytes retrieved (35.7% vs. 51.6%, P<0.001), and had a lower cLBR per patient (29.5% vs. 38.7%, P=0.006) when compared to non-POSEIDON patients. Expected low responders (POSEIDON 3-4) were older and had lower AMH when compared to unexpected low responders (POSEIDON 1-2), but no differences in the target of oocytes retrieved (33.3% vs. 37.3%, P=0.66) and cLBR (28.9% vs. 37.3%, P=0.06) were noted.

Conclusions: In expected low responders, follitropin-δ can be used to optimize oocyte collection and clinical outcome though one may need to deviate from the algorithm-suggested dose. Future studies should explore stimulation modifications in unexpected low responders.

根据 POSEIDON 分类确定的反应不佳者使用促性腺激素-δ进行体外受精的经验。
背景:体外受精(IVF)期间的控制性卵巢刺激是根据预期的高反应、正常反应和低反应进行个性化治疗的。对于反应较差的患者,通常使用更高的促性腺激素剂量以及尿液和重组促性腺激素(rFSH)联合疗法,但效果甚微,我们报告了我们在体外受精过程中使用更新、更强效的 rFSH(促卵泡素-δ)的经验:方法:回顾性分析三年来所有单独使用或与尿促性腺激素联合使用促性腺激素δ的体外受精周期。根据POSEIDON分类法,患者被分为预期低反应者(POSEIDON 3-4;AMHResults:被归类为 POSEIDON 患者的年龄较大,卵巢储备功能较低,更有可能使用混合方案,更不可能达到目标卵母细胞获取率(35.7% 对 51.6%,PC 结论):对于预期反应较低者,尽管可能需要偏离算法建议的剂量,但仍可使用促性腺激素-δ来优化卵母细胞采集和临床结果。未来的研究应探索意外低反应者的刺激调整。
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来源期刊
Minerva obstetrics and gynecology
Minerva obstetrics and gynecology OBSTETRICS & GYNECOLOGY-
CiteScore
2.90
自引率
11.10%
发文量
191
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