Once-Daily Hormonal Therapy More Effective Than Twice-Daily Dosing for Patients Undergoing IVF

SAN FRANCISCO — November 13, 2008 — For patients undergoing in vitro fertilization (IVF), once-daily dosing of hormonal therapy appears to be superior to twice-daily dosing, according to research presented here at the American Society for Reproductive Medicine (ASRM) 64th Annual Meeting.

The prospective, randomized, comparative, open-label study is one of the first of its kind to perform a side-by-side comparison of once-daily and twice-daily dosing of follicle stimulating hormone in combination with human menopausal gonadotropin (FSH:hMG).

"Our hypothesis — our expectation — was that we would find little difference between the 2 groups," explained investigator Carole Wegner, PhD, The Center for Reproductive Biology of Indiana, Indianapolis, Indiana, who presented the findings on November 11 on behalf of the research team.

In the study, 27 women received once-daily injections of FSH:hMG and 16 women received twice-daily injections of FSH:hMG. Patients were aged 24 to 42 years, and all underwent ovulation induction as part of the IVF process.

Study endpoints included the number of oocytes retrieved, fertilization rate, progression to blastocyst, and clinical pregnancy rates.

Results showed that the rate of pregnancy, as measured by fetal cardiac activity at 6 weeks, was much greater in the once-daily dosing than in the twice-daily regimen (85% vs 38%; P = .0077).

The final number of follicles recruited (P = .0348), the number of oocytes retrieved (P = .0397), and the number of blastocyst stage embryos produced (P = .02) was also significantly greater in the once-daily cohort.

The authors noted that the rate of IVF cancellation was higher in the twice-daily dosing cohort than in the once-daily group (20% vs 7%).

They concluded that the once-daily injection protocol was superior to the twice-daily regimen, based on a number of experimental endpoints, including pregnancy outcomes.

"We were pretty surprised to find the differences between the 2 groups," said Dr. Wegner.

Funding for this study was provided by Ferring Pharmaceuticals, Inc.

[Presentation title: Once-a-Day Injection Dosing for a Mixed (FSH:hMG) Stimulation Protocol Showed Superior Clinical Outcomes Compared to a Twice-a-Day Dosing Schedule. Abstract P-846]

Fertility Expert:

In our practice, we use the step down mixed stimulation protocol. The first 3 days, due to higher dosage, the patients have split doses. The remaining ofthe stimulation, with the step down, patients receive only once a day hormonal injection with satisfactory outcomes.

Read more at home page XPert Fertility Care.