Ricerc@Sapienza

Nowadays, around 15 to 20% of couples are infertile and the rate is increasing every year. Despite the improvement of assisted reproductive technologies(ART) in the last decades, a group of patients, called poor responders, who cover from 9 to 24% of the entire infertile population(Ubaldi et al. 2005, Patrizio et al. 2015), has not an optimal response to conventional stimulation. The results in term of live birth delivery rate(LBDR) in this category of patients is low and heterogeneous, and it is approximately 3 to 20%. Recent introduction of Bologna criteria for the definition of poor responder should reduce the heterogeneity of the results. Different type of exogenous follicle-stimulating hormone (FSH)(urinary human menopausal gonadotropin(HMGs), highly purified(hp)-HMG, recombinant-FSH(rec-FSH)( folllitropin alfa/follitropin beta/folitropin delta), corifollitropin alfa) combined in different protocols(agonist/antagonist protocol, short/long protocol) are available nowadays but no one demonstrate a strong change in the prognosis of these women. One of the most recent drugs tested in poor responder was corifollitropin alfa, able to initiate and sustain multiple follicular growth for an entire week. The addition of hp-HMG to corifollitropin alfa has demonstrated a non-inferiority efficacy in term of LBDR compared with traditional drugs. However, hp-HMG, unlike to corifollitropin alfa, contained both FSH and luteinizing hormone(LH) activity.
Since it has been demonstrated that adding LH supplementation improve outcome in poor responder, we want to test the effectiveness in term of LBDR of hp-HMG alone started at the beginning of the stimulation versus the combination of corifollitropin alfa followed to hp-HMG. For our knowledge this is the first study compared these two type of controlled ovarian stimulation(COS) in poor responder in a fixed antagonist protocol.