Ovarian Follicular Growth through Intermittent Vaginal Gonadotropin Administration in Diminished Ovarian Reserve Women

Abstract

It is a challenge to obtain enough oocytes during in vitro fertilization (IVF) in women who have a poor ovarian response (POR) in achieving conception. We have adopted the characteristics of the first uterine pass effect, which we pioneered in employing the vaginal administration of gonadotropins in women receiving IVF treatments. In our previous study employing vaginal administration, faster absorption and slower elimination of gonadotropins were demonstrated, and, female subjects presented proper ovarian follicle growth and pregnancy rates. In this study, during 2016–2020, 300 to 675 IU of gonadotropins were administered vaginally every three days in 266 POR women for their controlled ovarian hyperstimulation (COH). The injections were performed with needles angled at 15–30° towards the middle-upper portions of the bilateral vaginal wall, with an injection depth of 1–2 mm. For the COH results, these women, on average, received 3.0 ± 0.9 vaginal injections and a total dose of 1318.4 ± 634.4 IU gonadotropins, resulting in 2.2 ± 1.9 mature oocytes and 1.0 ± 1.2 good embryos. Among these embryos, 0.9 ± 1.0 were transferred to reach a clinical pregnancy rate of 18.1% and a live birth rate of 16.7%. In conclusion, the intermittent vaginal administration of gonadotropins proved to be effective in POR women for their IVF treatments.

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 ].…”