Extended Injection Intervals of Gonadotropins by Intradermal Administration in IVF Treatment

Abstract

Context Gonadotropins can be administered every five days under intradermal injection in in vitro fertilization (IVF) treatment. Objective To explore the effectiveness of intradermal injection of recombinant human FSH (rhFSH) for women undergoing IVF. Materials and Methods Women who received their first time IVF enrolled in this prospective intervention in 2018. All women received a bolus of 900 IU rhFSH intradermally at day 2 of the treatment cycle followed by additional dosage of rhFSH at day 7 and/or day 10. The main outcome measures included the total dose of rhFSH and number of injections required, sequential serum FSH level detected, and number of mature oocytes retrieved. Results Seventy women completed the study. On average, 2.31±0.73 injections and 1662±397 IU of rhFSH were administered. While the baseline FSH level was 5.6±2.2 IU/L, the serum concentrations of FSH after rhFSH administration were 35.3±7.0 on the first day (24 hours) and 10.7±3.7 IU/L on the fifth day (120 hours). A total of 10.5±6.6 mature oocytes were retrieved, resulting in 7.3±5.1 pronuclear embryos; and 1.8±0.6 embryos were transferred to the uterus. Our findings resulted in 72% fertilization, 91% cleavage, 31% implantation, and 36% live birth rates. Although less larger follicles were found, non-inferiority results were noted in the mature oocytes retrieved, good embryos available and clinical pregnancy rate compared to those received conventional daily subcutaneous rhFSH administration. Conclusion Intradermal administration of rhFSH, with less dose of rhFSH and numbers of injection, may achieve the goal of a cost-effective and more patient-friendly regimen.

Intraovarian Injection of Recombinant Human Follicle-Stimulating Hormone for Luteal-Phase Ovarian Stimulation during Oocyte Retrieval Is Effective in Women with Impending Ovarian Failure and Diminished Ovarian Reserve

“…In the era of increasing demand for more women, many with advanced age, with DOR/IOF request IVF treatments, different administration modes of rhFSH might optimize their response to COS. Our recent studies by administrating rhFSH in combination with PRP directly into the target ovarian tissue and also whole dimension subcortical ovarian administration indicated the restoration of ovarian function and clinical pregnancy in women with premature ovarian insufficiency and early menopause [ 15 , 16 ]. We have also demonstrated that both intradermally and intravaginally administered rhFSH can be absorbed efficiently and enhance ovarian follicle growth in POR women [ 17 , 19 , 29 , 30 , 31 ]. Thus, a personalized IVF treatment with fine-tuning of the Gn dose in accordance with each individual’s ovarian response has become a safe and effective practice [ 32 , 33 ].…”

“…Double stimulation was employed immediately following the oocyte retrieval procedure in the operating room. The routine COS at our IVF unit is intermittent superficial subcutaneous/intradermal administration (the term intradermal administration will be used in the main article) of rhFSH [ 17 ]. The injection of Gn was performed on Days 2, 5, and 8 of the IVF cycle in accordance with our routine COS method [ 17 ].…”

“…The routine COS at our IVF unit is intermittent superficial subcutaneous/intradermal administration (the term intradermal administration will be used in the main article) of rhFSH [ 17 ]. The injection of Gn was performed on Days 2, 5, and 8 of the IVF cycle in accordance with our routine COS method [ 17 ]. In brief, 300 IU rhFSH (Gonal-f Prefilled Pen 300 IU rhFSH in 0.5 mL, Merck Serono S.p.A., Modugno, Italy) in combination with Menopur 375 IU (Menopur 75 IU, corresponding to FSH 75 IU and LH 75 IU; FerringGmBH, Kiel, Germany) reconstituted in 1 mL solvent was aspirated into a 2.5 mL syringe.…”

“…The oocyte retrieval procedures were carried out in accordance with our routine method [ 17 ]. In brief, oocyte retrieval was performed 36 h after triggering the final follicular maturation using 6500 IU recombinant hCG (Ovidriel, Merck SeronoS.p.A., Modugno, Italy) when at least one follicle reached ≥ 15 mm in diameter.…”