Corifollitropin alfa for ovarian stimulation in in vitro fertilization: a systematic review and meta-analysis of randomized controlled trials

Objective To evaluate the effectiveness of corifollitropin alfa in improving the success of IVF. Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) Infertile women undergoing conventional IVF or intracytoplasmic sperm injection (ICSI). Intervention(s) Randomized controlled trials (RCTs) of infertile women undergoing a single IVF/ICSI cycle with either corifollitropin alfa or a conventional ovarian stimulation protocol based on daily injections. The review protocol was registered in PROSPERO before starting the data extraction (CRD42018088605). Main Outcome Measure(s) Primary outcomes were live birth rate and/or ongoing pregnancy rate. Clinical pregnancy rate, miscarriage rate, multiple pregnancies, number of oocytes and embryos obtained, cancellation rate, and rate of ovarian hyperstimulation syndrome and ectopic pregnancy were considered as secondary outcomes. Result(s) Eight randomized controlled trials were included; 2,345 women were assigned to the intervention group and 1,995 to the control group. The analysis of 4,340 IVF cycles did not reveal any difference in live birth rate and/or ongoing pregnancy rate between groups (risk ratio [RR], 0.92; 95% confidence interval [CI], 0.80–1.05). Similarly, no difference was found in clinical pregnancy rate (RR, 0.96; 95% CI, 0.88–1.05; I2 = 0%), miscarriage rate (RR, 0.94; 95% CI, 0.71–1.25; I2 = 0%), or multiple pregnancy rate (RR, 1.22; 95% CI, 0.99–1.50; I2 = 0%). Also, the rates of cycle cancellation, ovarian hyperstimulation syndrome, and ectopic pregnancy were similar in both groups. Sensitivity and subgroup analyses did not provide statistical changes to pooled results. Conclusion(s) Corifollitropin alfa seems to be an alternative for daily recombinant FSH injections in normal and poor responder patients undergoing ovarian stimulation in IVF/ICSI treatment cycles.