使用長效型排卵針corifollitropin alpha (CFA) vs 使用短效型排卵針(Gona-F, Puregon)
引發早期黃體化(P4>1.5 ng/ml)比率: 5.4% vs 18.3%
長效型排卵針較不會引發早期黃體化

Hum Reprod. 2016 Sep 12. [Epub ahead of print]

Impact of gonadotropin type on progesterone elevation during ovarian stimulation in GnRH antagonist cycles.

Lawrenz B1, Beligotti F2, Engelmann N3, Gates D4, Fatemi HM3.

Author information

Abstract

STUDY QUESTION:

Does hormonal stimulation with corifollitropin alpha (CFA) only, mimicking a step down protocol, result in lower incidence of progesterone elevation on the day of hCGtrigger as compared to sustained stimulation with recombinant FSH (rFSH)?

SUMMARY ANSWER:

The current findings support the concept that sustained FSH stimulus contributes to premature progesterone elevation in stimulated IVF cycles.

WHAT IS KNOWN ALREADY:

Serum progesterone rise during the follicular phase of ovarian stimulation for IVF treatment seems to be related to a poorer reproductive outcome. However, the mechanism by which the rise in progesterone is caused is not yet fully understood.

STUDY DESIGN, SIZE, DURATION:

This study was a post hoc analysis of data from two multi-center, randomized, double-blind, double-dummy, active-controlled, non-inferiority trials, ENGAGE and PURSUE, conducted from June 2006 to January 2008 and from July 2010 to October 2012 respectively.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

In the ENGAGE-study, 1506 women, aged 18-36 years, were allocated to either a single injection of 150 mg CFA or daily injections of 200 IU rFSH in the first week of stimulation, using a standard GnRH antagonist protocol. In the PURSUE-study, a total of 1390 women, aged 35-42 years, were allocated to either a single injection of 150 mg of CFA or daily 300 IU of rFSH for the first week, again using a standard GnRH antagonist protocol. In both trials, daily rFSH was continued until three follicles reached >17 mm in size. All women had a body weight of between 50 and 90 kg, regular menstrual cycles and an indication for ovarian stimulation before IVF. The incidence of progesterone elevation on day of hCG-trigger in patients with CFA only or rFSH stimulation, and triggered on Day 8 of stimulation, was analyzed.

MAIN RESULTS AND THE ROLE OF CHANCE:

Of patients with CFA only stimulation, 5.4% (13/239 patients) showed a progesterone elevation above 1.5 ng/ml on day of hCG-trigger, whereas patients with rFSH stimulation had a significant higher incidence of progesterone elevation (18.3%; 62/339 patients) (P < 0.001).