corifollitropin alfa (CFA) + intra-nasal GnRH agonist  (CFA flare)

VS

corifollitropin alfa (CFA) +GnRH antagonist

前者CFA flare方案是可取代傳統的卵巢刺激方案，用於治療卵巢反應不良的患者。

此方案顯著減輕了患者的負擔，減少了FSH注射次數，且無需注射GnRH拮抗劑。

CFA flare protocol is a novel alternative to conventional ovarian stimulation regimens that are used for ‘poor responder’ patients. It significantly reduces the patient burden, with less injections of FSH and no injections of GnRH antagonist. The ovarian response is similar to that achieved with a conventional GnRH antagonist cycle, 

An injection-lite approach to ovarian stimulation in poor responder patients using corifollitropin alfa and nasal GnRH agonist

Can the unique pharmacokinetic and pharmacodynamic profiles of corifollitropin alfa (CFA) in combination with an intra-nasal GnRH agonist (CFA flare) provide adequate ovarian stimulation for poor-responder patients while minimising the burden of injections?

Methods

Twenty women aged between 31 and 41 years of age who were identified as potential poor responders to ovarian stimulation according to the POSEIDON criteria and who were attending the Fertility and Research Centre, Royal Hospital for Women and City Fertility, Sydney for IVF treatment were randomised to receive either the flare or the antagonist cycle. Serum FSH, LH, and E2 concentrations were measured daily for 5 days post-initiation of CFA during the early follicular phase.

Results

The number of injections given to women in the CFA flare arm (4) was significantly less than those in the CFA antagonist arm (11), (p = 0.001).

Two days after the initiation of CFA, serum FSH concentrations were 27 versus 11 IU/L (flare versus antagonist) (p = 0.022), and mean serum E2 concentrations were 349 versus 157 pmol/L (p = 0.039), and on day 7, were 3000 versus 1850 pmol/L.

The CFA flare stimulation protocol resulted in higher concentrations of FSH in the early period of follicular stimulation. There was an equivalent rise in serum E2 in both groups. The CFA flare protocol was non-inferior to the CFA antagonist protocol and may have been less burdensome to patients as fewer injections were needed.

Conclusion

The CFA flare protocol is a novel alternative to conventional ovarian stimulation regimens that are used for ‘poor responder’ patients. It significantly reduces the patient burden, with less injections of FSH and no injections of GnRH antagonist. The ovarian response is similar to that achieved with a conventional GnRH antagonist cycle, but this requires further evaluation in a larger study.

用1 mM N-乙醯半胱氨酸（NAC）處理的卵母細胞與其他實驗組相比，卵裂率較高。

Oocytes treated with 1 mM N-acetylcysteine (NAC)  showed higher cleavage rates compared to the other experimental groups

Effect of in vitro maturation medium supplementation with N-acetylcysteine on the developmental competence of sheep oocytes

The present study aimed to evaluate the effect of N-acetylcysteine (NAC) on in vitro maturation (IVM) and in vitro embryo production in sheep. Cumulus–oocyte complexes (COCs) were collected and matured in vitro in a control medium or supplemented with different concentrations of NAC (1, 1.5 and 2.0 mM). After maturation, a subset of oocytes was used for morphological assessment and chromatin configuration analysis, as well as for evaluating intracellular levels of reactive oxygen species (ROS), glutathione (GSH), mitochondrial activity and DNA fragmentation using the TUNEL assay. Another subgroup of oocytes was subjected to in vitro fertilization (IVF), and the presumed zygotes were cultured in in vitro culture (IVC) medium to assess cleavage rates. Data were statistically analysed, considering significance at P < 0.05. The concentration of 1 mM NAC resulted in lower ROS levels compared to the control and 1.5 mM groups, in addition to reducing DNA fragmentation. No significant differences (P > 0.05) were observed in GSH levels or mitochondrial activity between treated and control groups. Furthermore, oocytes treated with 1 mM NAC showed higher cleavage rates compared to the other experimental groups. In conclusion, supplementation with 1 mM NAC improves oocyte quality and early embryonic development, as demonstrated by reduced oxidative stress and DNA fragmentation, resulting in increased cleavage rates.

• 嵌合體胚胎的著床率和活產率顯著低於整倍體胚胎，
• 一旦著床發生兩組的生化懷孕流失率和流產率相當，顯示著床是嵌合體胚胎存活的主要限制因素。
• 節段性嵌合體的預後優於全染色體嵌合體。

Meta-Analysis

 

. 2025 Aug;42(8):2469-2481.

doi: 10.1007/s10815-025-03575-6. Epub 2025 Jul 10.

Live birth and other reproductive outcomes of mosaic and euploid embryos: a systematic review and meta-analysis

Advances in preimplantation genetic testing for aneuploidy (PGT-A) have improved embryo selection in assisted reproductive technologies (ART). However, the clinical significance of mosaic embryos remains uncertain. This systematic review and meta-analysis evaluates reproductive outcomes following mosaic embryo transfer compared to euploid embryos. Live birth rate was the primary outcome, while secondary outcomes included biochemical pregnancy, biochemical pregnancy loss, miscarriage, clinical pregnancy, ongoing pregnancy, and neonatal outcomes. Our findings indicate that mosaic embryos have significantly lower implantation and live birth rates than euploid embryos, reinforcing the superior reproductive potential of euploid embryos. However, once implantation occurs, biochemical pregnancy loss and miscarriage rates were comparable between groups, suggesting that implantation is the primary limiting factor in mosaic embryo viability. The type and extent of mosaicism may further influence reproductive outcomes, with segmental mosaicism showing better prognoses than whole-chromosome mosaicism. Additionally, a trend toward lower birth weight in mosaic embryos was observed, though neonatal health outcomes remained as favorable as euploid embryos. The heterogeneity in diagnostic and reporting criteria highlights the need for standardized classification of mosaicism to enhance prognostic accuracy. Further research is required to refine embryo selection strategies and improve clinical decision-making in ART.