Sequential protocol with urinary-FSH/recombinant-FSH versus standard protocol with recombinant-FSH in women of advanced age undergoing IVF

Abstract

A stimulation protocol mimicking the physiological pattern of FSH release may improve IVF outcome in women of advanced age. Urinary-FSH delivers a wider range of isoforms including the most acidic produced during the early follicular phase when oestradiol level is low, a common condition in women of advanced reproductive age. We hypothesized that a stimulation protocol using urinary-FSH during the early follicular phase and then shifting toward recombinant-FSH may improve oocyte quality and pregnancy rate in 35–40 years old patients in IVF program. A retrospective study was performed: after a standard down-regulation with GnRH-analogue, 115 women underwent stimulation with urinary-FSH for 6 days according to a step-down approach and then shifting to recombinant-FSH (group A), 115 women underwent a stimulation protocol with only recombinant-FSH (group B). Days of stimulation were lower in group A than in group B, a higher proportion of MII oocytes and of grade 1 embryos, higher implantation rate and pregnancy rate were observed in group A versus group B. We conclude that a sequential protocol using urinary-FSH in the early days of stimulation and subsequently recombinant-FSH may improve the IVF outcome in patients of advanced reproductive age.

Chinese abstract

刺激方案通过模拟人体内FSH释放的生理学特性可能会提高高龄妇女IVF的妊娠结局。尿源性FSH提供了更多的亚型，包括酸性最强的亚型，该亚型只在雌二醇水平很低的早卵泡期产生。这种情况在高生育年龄患者中常见。假设对30-40岁患者行IVF促排卵过程中早卵泡期应用尿源性FSH而后转为应用重组FSH，该方案可能会提高卵子质量和妊娠率。一项回顾性研究显示：通过标准的GnRH-a降调节方案，115名患者前6天接受尿源性FSH刺激而后转为重组FSH刺激（A组），另外115名患者仅接受重组FSH刺激方案（B组）。与B组相比，A组刺激天数更少、MII卵细胞和一级胚胎比例较多且有更高的移植率和妊娠率。因而我们得出结论：在早期应用尿源性FSH而后转用重组FSH刺激的序贯方案可以提高高龄妇女的IVF结局。

• Advanced reproductive age
• ART
• FSH
• infertility
• oocyte quality

Notice of Correction

The version of this article published online ahead of print on 20 Jun 2014 contained an error in the author list. The author list “Colacurci Nicola, Caprio Francesca, La Verde Eugenio, Trotta Carlo, Ianniello Raffaele, Mele Daniela, and De Franciscis Pasquale” should have read “Nicola Colacurci, Francesca Caprio , Eugenio La Verde, Carlo Trotta, Raffaele Ianniello, Daniela Mele, and Pasquale De Franciscis.” Each author was mistakenly listed with their surnames first, followed by their given names. The error has been corrected for this version.