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Shu L, Xu Q, Meng Q, Dai X, Zhang Y, Zhou W, Yi H, Liu J, Wu C, Hou Z, Cui Y, Li TC, Liu J. Clinical outcomes following long GnRHa ovarian stimulation with highly purified human menopausal gonadotropin plus rFSH or rFSH in patients undergoing in vitro fertilization-embryo transfer: a multi-center randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:146. [PMID: 31157267 DOI: 10.21037/atm.2019.04.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This clinical trial aimed to compare the clinical efficacy of highly purified human menopausal gonadotropin (HP-HMG) plus recombinant human follicle-stimulating hormone (rFSH) versus rFSH alone on controlled ovarian stimulation (COS) in vitro fertilization-embryo transfer (IVF-ET). Methods A total of 610 women underwent long gonadotropin-releasing hormone (GnRH) agonist protocol for IVF treatment. The subjects were randomized into 2 groups: HP-HMG + rFSH group (n=305) and rFSH group (n=305). The main outcome was the progesterone (P) level on the day of HCG injection. Results There was no significant difference in terms of the demographic and baseline characters between the two groups. In rFSH group, the P level on the day of HCG trigger were significantly higher than that of HP-HMG+rFSH group (4.3±2.2 vs. 3.8±1.7 nmol/L, P<0.001). The fertilization rate in rFSH group was significantly lower than that of HP-HMG + rFSH group (69.2% vs. 73.9%, P<0.001). Simultaneously, the percentage of cycles with fresh embryo transfer in rFSH group was also significantly lower than that of HP-HMG + rFSH group (49.6% vs. 57.5%, P=0.007). However, there was no difference in terms of cleavage rate, implantation rate, clinical pregnancy rate and ovarian hyperstimulation syndrome (OHSS) rate between two groups. Conclusions The use of combined HP-HMG with FSH may be superior to rFSH alone in stimulating the ovary in normal responders undergoing IVF treatment. Furthermore, the further prospective studies with large sample are still needed to confirm the study.
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Affiliation(s)
- Li Shu
- Center of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qianhua Xu
- Center of Reproductive Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Qingxia Meng
- Center of Reproductive Genetics, Suzhou Municipal Hospital, Suzhou 215000, Chin
| | - Xue Dai
- Center of Reproduction, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Yun Zhang
- Center of Reproduction, Wuxi Maternal and Child Health Care Hospital, Wuxi 214000, China
| | - Wei Zhou
- Center of Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou 213000, China
| | - Honggang Yi
- Statistics Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jinyong Liu
- Center of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chunxiang Wu
- Center of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhen Hou
- Center of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yugui Cui
- Center of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Tin Chiu Li
- Reproductive Medicine and Surgery Unit, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Jiayin Liu
- Center of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Schertz J, Worton H. Nurse evaluation of the redesigned fertility pen injector: a questionnaire-based observational survey. Expert Opin Drug Deliv 2018. [PMID: 29521156 DOI: 10.1080/17425247.2018.1450386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Owing to the wide-ranging role nurses have in supporting patients undergoing fertility treatment, we recorded the learning/teaching expectations and experiences of nurses using a redesigned fertility pen injector. METHODS This was a multicentre, simulated-use study, using unbranded placebo-filled pens. Before teaching patients, nurses were given free choice to rank the importance of the device attributes and predict the level of patient anxiety. Nurses taught 2-5 patients how to prepare the device, inject the dose and complete an incomplete dose. They rated the teaching experience on a 5-point scale during a questionnaire interview. RESULTS Thirty nurses were enrolled across four countries. All nurses found the redesigned fertility pen injector easy to use and teach. 90% found the overall administration process easy to learn and teach. More than 80% (range 83%-100%) found each of the steps easy (score 4 or 5), and most found the steps easier to teach than expected (score 4 or 5; range 57%-90%). 97% would recommend the redesigned fertility pen injector to a colleague. CONCLUSIONS Nurses rated the redesigned fertility pen injector easy to learn and use and easier to teach than expected. Most would recommend the device to a colleague.
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Affiliation(s)
- Joan Schertz
- a Global Clinical Development , EMD Serono Research and Development Institute , Billerica , MA , USA
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Upadhyay UD, Zlidar VM, Foster DG. Interest in self-administration of subcutaneous depot medroxyprogesterone acetate in the United States. Contraception 2016; 94:303-13. [PMID: 27326938 DOI: 10.1016/j.contraception.2016.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/08/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a low-dose formulation of depot medroxyprogesterone acetate (DMPA) that nonmedical personnel can administer safely and effectively. We sought to determine United States women's interest in self-administration of DMPA-SC to understand whether such use can overcome barriers to contraceptive access. STUDY DESIGN We analyzed survey data on contraceptive attitudes collected in March-July 2011 from 1592 women at 13 family planning and six abortion clinics throughout the US. A mixed-effects logistic regression model with random site effects examined the determinants of interest in self-administering DMPA-SC. RESULTS Overall, 21% [95% confidence interval (CI): 19%-23%] of women reported interest in self-administration. A multivariable model found that women currently using DMPA (Adjusted Odds Ratio [AOR]=3.93, 95% CI: 2.37-6.53, p<.001) and women who previously used DMPA (AOR=1.71, 95% CI: 1.26-2.32, p<.001) were more likely to have an interest in DMPA-SC than those who never used it. Women reporting difficulty obtaining or refilling a prescription were almost twice as likely to have interest in DMPA-SC as women who reported no difficulty (AOR=1.99, 95% CI: 1.43-2.77, p<.001). Women surveyed at abortion sites were more likely to report interest in self-administration than women surveyed at family planning sites (AOR=1.55, 95% CI: 1.05-2.30, p<.05). Interest in DMPA-SC was primarily driven by a desire to eliminate unnecessary return visits to a facility for repeat injections. CONCLUSIONS Offering women the option to self-administer DMPA-SC at home can expand access and tailor contraceptive provision to the needs of clients, thus supporting client-centered care. To the extent that self-administration may improve contraceptive continuation, DMPA-SC can prevent unintended pregnancies among women who discontinue DMPA use because of difficulty returning for repeat injections. IMPLICATIONS There is substantial interest in self-administration of DMPA-SC among current DMPA users, women who have recently had an abortion and women reporting difficulty returning to a family planning provider. Offering self-administration of DMPA-SC could potentially increase contraceptive continuation, reduce unintended pregnancies and enhance reproductive autonomy among DMPA users.
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Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology & Reproductive Science, University of California, San Francisco, San Francisco, CA 94612, USA.
| | | | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology & Reproductive Science, University of California, San Francisco, San Francisco, CA 94612, USA.
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Sequential (hFSH + recFSH) vs homogenous (hFSH or recFSH alone) stimulation: clinical and biochemical (cumulus cell gene expression) aspects. J Assist Reprod Genet 2014; 31:657-65. [PMID: 24639041 DOI: 10.1007/s10815-014-0208-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/28/2014] [Indexed: 01/16/2023] Open
Abstract
FSH is a key hormone in the regulation of follicular development. Together with the EGF network, these molecules mediate oocyte maturation and competence in preparation for the action of LH. FSH isoforms regulate distinct biological pathways and have specific effects on granulosa cell function and maturation of the ovarian follicle. Their dynamic interactions occur during the follicular cycle; short-living forms are predominant in the pre-ovulatory phase, whereas long-acting molecules characterize the luteal-follicular transition. Recombinant FSH (rFSH) molecules have a reduced number of isoforms and are less acidic, with a shorter half-life. We have investigated sequential stimulation, comparing hFSH + rFSH, vs. rFSH alone and hFSH alone for the entire stimulation phase. Sequential stimulation leads to an E2 per MII oocyte ratio that is much lower than is seen during treatment with the two drugs individually. Although there is a positive tendency in favor of the sequential treatment, there was no significant difference in pregnancy rates, even taking frozen embryos into consideration. The cumulus cell transcriptome varies considerably between the treatments, although with no clear significance. When comparing pregnant vs. non-pregnant patients, in general a decrease in mRNA expression can be observed in the pregnant patients, especially in expression of folic acid receptor 1 and ovostatin 2. This indicates that material has been transferred from CC to the oocyte. However, a common observation in the literature is that variations in the transcriptome of the cumulus cells are highly dependent upon the patient genotype; the potential for applying this strategy as a basis for selecting embryos is, at the very least, questionable.
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Utsunomiya T, Tanaka A, Tatsumi K, Ezcurra D. A questionnaire-based survey to assess patient satisfaction, ease-of-learning, ease-of-use, injection site pain and overall patient satisfaction of the follitropin-alpha (Gonal-f) filled-by-mass (FbM) prefilled pen compared with other systems of gonadotrophin administration. Reprod Biol Endocrinol 2012; 10:93. [PMID: 23167906 PMCID: PMC3567994 DOI: 10.1186/1477-7827-10-93] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gonadotrophins are used routinely for follicular stimulation during ovarian induction and assisted reproduction techniques. Developments in recombinant follicle-stimulating hormone preparations and their injection devices have improved patient quality of life by enabling patients to self-administer treatment at home. The objective of this study was to investigate patient experiences of learning to use and overall satisfaction with the follitropin-alpha (Gonal-f) filled-by-mass (FbM) prefilled pen. METHODS This questionnaire-based survey study was conducted in 23 fertility centres in Japan over a period of 14 months. Patients who were receiving fertility treatment with the follitropin-alpha (FbM) prefilled pen were asked to complete a questionnaire to assess their satisfaction, ease of learning and use, and injection site pain following treatment. RESULTS A total of 663 women participated in the study. The majority of patients found the instructions for administering follitropin-alpha with the prefilled pen easy to understand (83.0%; n = 546/658) and patients found that a hands-on demonstration by a nurse or doctor was the most useful tool for learning to use the follitropin-alpha (FbM) prefilled pen (80.0%; n = 497/621). Forty-eight percent (n = 318) of patients in the study had previous experience with different types of fertility medications and the majority of these patients found the follitropin-alpha (FbM) prefilled pen easier to use (75.1%; n = 232/309) and less painful (89.0%; n = 347/390) than their previous medication. The majority (80.2%; n = 521/650) of patients reported overall satisfaction with the follitropin-alpha (FbM) prefilled pen. CONCLUSIONS The follitropin-alpha (FbM) prefilled pen is an easy-to-use injection device according to this questionnaire-based survey. Patients who had experience of different types of fertility medication preferred the follitropin-alpha (FbM) prefilled pen to other injection devices.
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Affiliation(s)
- Takafumi Utsunomiya
- Japanese Institution for Standardizing Assisted Reproductive Technology, Osaka, Japan
| | - Atsushi Tanaka
- Japanese Institution for Standardizing Assisted Reproductive Technology, Osaka, Japan
| | - Kenichi Tatsumi
- Japanese Institution for Standardizing Assisted Reproductive Technology, Osaka, Japan
| | - Diego Ezcurra
- Fertility and Endocrinology Business Unit, Merck Serono SA, Geneva, Switzerland
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Schertz JC, Saunders H, Hecker C, Lang B, Arriagada P. The redesigned follitropin alfa pen injector: results of the patient and nurse human factors usability testing. Expert Opin Drug Deliv 2011; 8:1111-20. [DOI: 10.1517/17425247.2011.608350] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cheon KW, Song SJ, Choi BC, Lee SC, Lee HB, Yu SY, Yoo KJ. Comparison of clinical efficacy between a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) and daily administrations of short-acting GnRHa in in vitro fertilization-embryo transfer cycles. J Korean Med Sci 2008; 23:662-6. [PMID: 18756054 PMCID: PMC2526402 DOI: 10.3346/jkms.2008.23.4.662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study was aimed to evaluate the efficacy of a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) as compared with daily administrations of short-acting GnRHa in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) cycles. The mean dosage of recombinant follicle-stimulating hormone (rFSH) required for COH (2,354.5+/-244.2 vs. 2,012.5+/-626.1 IU) and the rFSH dosage per retrieved oocyte (336.7+/-230.4 vs. 292.1+/-540.4 IU) were significantly higher in the long-acting GnRHa group (N= 22) than those in the short-acting GnRHa group (N=28) (p<0.05). However, the mean number of visit to the hospital that was required before ovum pick-up (3.3+/-0.5 vs. 22.2+/-2.0) and the frequency of injecting GnRHa and rFSH (12.8+/-1.2 vs. 33.5+/- 3.5) were significantly decreased in the long-acting GnRHa group (p<0.0001). The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different between the 2 groups. So, we suggest that a single administration of long-acting GnRHa is a useful alternative for improving patient's convenience with clinical outcomes comparable to daily administrations of short-acting GnRHa in COH for IVF-ET cycles.
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Affiliation(s)
- Kang Woo Cheon
- Laboratory of Reproductive Medicine, Samsung Women's Hospital, Suwon, Korea
| | - Sang Jin Song
- Laboratory of Reproductive Medicine, Creation and Love Women's Hospital, Gwangju, Korea
| | - Bum Chae Choi
- Department of Obstetrics and Gynecology, Creation and Love Women's Hospital, Gwangju, Korea
| | - Seung Chul Lee
- Department of Obstetrics and Gynecology, Samsung Women's Hospital, Suwon, Korea
| | - Hong Bok Lee
- Department of Obstetrics and Gynecology, Samsung Women's Hospital, Suwon, Korea
| | - Seung Youn Yu
- Department of Obstetrics and Gynecology, Samsung Women's Hospital, Suwon, Korea
| | - Keun Jai Yoo
- Department of Obstetrics and Gynecology, Creation and Love Women's Hospital, Gwangju, Korea
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Rama Raju GA, Suryanarayana K, Jaya Prakash G, Murali Krishna K. Comparison of follitropin-beta administered by a pen device with conventional syringe in an ART programme - a retrospective study. J Clin Pharm Ther 2008; 33:401-7. [PMID: 18613858 DOI: 10.1111/j.1365-2710.2008.00931.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study compares the efficacy and patient tolerance of follitropin-beta (recagon) administered using a pen device with conventional syringe in infertile couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. METHODS Data for 481 patients were retrieved retrospectively for the analysis. Conventional syringe group constituted 204 patients with 217 cycles and 265 patients with 294 cycles in the pen-device group. Down-regulation was achieved with GnRH agonist. RESULTS Comparison of follitropin-beta administered with pen and syringe showed the following data, respectively. A total dose of 1909.38/2100.65 IU (P < 0.001), duration of stimulation, 9.70/10.47 days (P < 0.05), oestradiol levels on the day of human chorionic gonadotropin, 1488.34/1067.63 pg/ml, number of follicles reaching >16-mm size, 9.75/7.34 (P < 0.05), number of oocytes retrieved, 13.84/9.55 (P < 0.001) and number of embryos available for freezing, 4.56/1.30 (P < 0.05), the above data were observed in pen/conventional syringe groups, respectively. The live birth rates per cycle were 28.85% and 30.95% in the conventional syringe/pen-device groups, respectively. Patient tolerance with respect to pain at injection site was better with the pen device (P < 0.025). CONCLUSION The data show that follitropin-beta administered with pen device is well tolerated and more efficacious with respect to ovarian stimulation outcome compared with the conventional syringe.
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Affiliation(s)
- G A Rama Raju
- Krishna IVF Clinic, Visakhapatnam, Andhra Pradesh, India.
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