Extended Injection Intervals of Gonadotropins With Superficial Skin Administration In Ivf Treatment Is both Cost-Effective and Patient-Friendly

Abstract

BackgroundWomen undergoing IVF treatments have to receive daily injections of rFSH for multiple follicles growth based on the short half-life of rFSH administered subcutaneously. This study was designed to assess if longer intervals of injection, based on rFSH half-life of 102 hours under superficial subcutaneous administration, effective for women receiving IVF.MethodsOne hundred women, aged 25–45, requesting IVF treatments from January to December 2018 were recruited in this observatory study. All women received long protocol employing GnRH-agonist since day 18 of the previous cycle. An initial bolus of 900 IU rFSH was injected into superficial subcutaneous skin at day 2 of the treatment cycle followed by longer intervals with added doses at day 7 and/or day 10. The main outcomes included the dose of gonadotropin and numbers of injection, serum FSH level, and mature oocytes retrieved.ResultsA total of 70 women completed the treatments, in which 10, 30, and 30 women received one, two and three injections of rFSH, respectively. On average, 2.31 ± 0.73 numbers of Gn injection and 1662 ± 397 IU of rFSH were administered. In comparison with baseline FSH level of 5.6 ± 2.2 IU/L, the serum concentrations of FSH were 35.3 ± 7.0 to 10.7 ± 3.7 IU/L at 1 to 5 days after an initial 900 IU rFSH administration. There were 10.5 ± 6.6 mature oocytes retrieved which resulted in 7.3 ± 5.1 two pronuclei embryos, and 1.8 ± 0.6 embryos were transferred back to the uterus and the remaining embryos were cryopreserved. In total, 72%, 91%, and 31% were noted for fertilization, cleavage, and implantation rates, respectively. The cumulative live birth rate was 36%.ConclusionsBased on the serum FSH levels detected, rFSH only needs to be administered every five days instead of daily injection. This administration mode with less injections and much less expenses for gonadotropin might reach the goal of a more patient-friendly and cost-effective treatment for IVF. Regarding higher response and efficacy of the present study, this administration mode could be employed in women with poor ovarian reserve and in women of poor or suboptimal ovarian response.Trial registration: None