Ovarian response markers lead to appropriate and effective use of corifollitropin alpha in assisted reproduction

• Published in: Reproductive biomedicine online 2014-02, Vol.28 (2), p.183-190
• Main Authors: La Marca, Antonio, D’Ippolito, Giovanni
• Format: Article
• Language: English
• Subjects: Anti-Mullerian Hormone - blood; anti-Müllerian hormone; antral follicle count; Biomarkers - metabolism; corifollitropin alpha; Dose-Response Relationship, Drug; Female; Follicle Stimulating Hormone, Human - administration & dosage; Follicle Stimulating Hormone, Human - pharmacology; Humans; IVF; Obstetrics and Gynecology; OHSS; Ovarian Follicle - metabolism; Ovarian Hyperstimulation Syndrome - prevention & control; ovarian stimulation; Ovary - drug effects; Ovary - metabolism; Ovulation Induction - methods; Pregnancy
• ISSN: 1472-6483; 1472-6491
• DOI: 10.1016/j.rbmo.2013.10.012

Abstract Corifollitropin alpha is a highly effective gonadotrophin, which maintains multifollicular growth for a week. The advantages of its administration include ease of use of the drug, making the treatment more patient friendly, resulting in a lower level of distress for the patient. At the same time, the pregnancy rate resulting from its use in IVF/intracytoplasmic sperm injection cycles is similar to that found when daily recombinant FSH is administered. The ovarian response to corifollitropin alpha is dependent on clinically established predictors such as baseline FSH, antral follicle count (AFC) and age. There is a general trend towards a higher ovarian response with an increasing AFC and the number of oocytes per attempt decreased with increasing baseline FSH and age. Even if the risk of ovarian hyperstimulation syndrome following corifollitropin alpha is very similar to the rate reported in literature for young women undergoing IVF, the risk of overstimulation may be reduced by avoiding maximal ovarian stimulation in women anticipated to be hyperresponders. High basal anti-Müllerian hormone and/or AFC can identify women with enhanced functional ovarian reserve at risk of overstimulation, and the risk is even higher if maximally stimulated with corifollitropin alpha or high dose of daily recombinant FSH. Corifollitropin alpha is a highly effective gonadotrophin which maintains multifollicular growth for a week. The ovarian response to corifollitropin was demonstrated to be dependent on clinically established predictors such as baseline FSH, antral follicle count (AFC) and age. There was a general trend toward a higher ovarian response with an increasing AFC and the mean number of oocytes per attempt decreased with increasing baseline FSH and age. Even if the risk of ovarian hyperstimulation syndrome (OHSS) following corifollitropin alpha is very similar to the rate of OHSS reported in literature for young women undergoing IVF, the risk of overstimulation may be reduced by avoiding maximal ovarian stimulation in women anticipated to be hyperresponders. Increasing evidence demonstrates that anti-Müllerian hormone and AFC exhibit a very good diagnostic performance in the prediction of hyperresponse. High basal anti-Müllerian hormone and/or AFC can identify women with enhanced functional ovarian reserve who are at risk of overstimulation if stimulated in IVF cycles and the risk is even higher if maximally stimulated with corifollitropin alpha or high